Bleeding peptic ulcers: audit of eradication treatment for H pylori.
OBJECTIVE
To determine the outcomes after presentation with bleeding peptic ulcer and to assess the implementation of H. pylori testing, treatment and follow-up testing.


METHODS
Case notes and endoscopy records of patients presenting to Auckland Hospital between 1993-95 were reviewed. Patients were recalled for interview and urea breath test.


RESULTS
Mean follow-up after presentation was three years. Eighty-nine patients were reviewed; 62% were confirmed as H. pylori positive, although 20% had no biopsies. H. pylori eradication treatment was given to 49 patients. Thirty-five patients had a definite treatment success; eight were failures (eradication rate of 81%) and six received treatment without proof of H. pylori by biopsy. Forty patients received acid suppression only. Twelve patients had biopsy evidence of H. pylori, and a further nine were proven H. pylori positive at follow-up by urea breath test (initial tests had been negative or not performed). Nine patients had a rebleed; seven were confirmed H pylori positive either at presentation, or by follow-up breath test or endoscopic biopsies.


CONCLUSIONS
The incidence of H. pylori in patients with bleeding peptic ulcer is underestimated and many infected patients do not receive eradication treatment. Rebleeding is largely preventable if more attention is given to diagnosis and treatment of H. pylori and follow-up of treatment with a urea breath test.
Garrigan
K
K
Department of Medicine, University of Auckland.
McIntosh
C
C
Fraser
A G
AG
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001944:Breath Tests; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology* / Q000473:pathology; D012008:Recurrence; D016896:Treatment Outcome; D014508:Urea / Q000737:chemistry
D000900:Anti-Bacterial Agents; D006635:Histamine H2 Antagonists; D014508:Urea