Will Helicobacter pylori affect short-term rebleeding rate in peptic ulcer bleeding patients after successful endoscopic therapy?
OBJECTIVE
Helicobacter pylori (H. pylori) can augment the pH-increasing effect of omeprazole in patients with peptic ulcer. A high intragastric pH may be helpful in preventing recurrent hemorrhage by stabilizing the blood clot at the ulcer base of bleeding peptic ulcer patients. Therefore, we hypothesized that omeprazole may reduce short-term rebleeding rate in these patients with H. pylori infection after initial hemostasis had been obtained.


METHODS
Between July 1996 and December 1998, 65 bleeding peptic ulcer patients (24 gastric ulcer, 41 duodenal ulcer) who had obtained initial hemostasis with endoscopic therapy were enrolled in this trial. Thirty (46.2%) of them were found to have H. pylori infection by a rapid urease test and pathological examination. For all studied patients, omeprazole was given 40 mg intravenously every 6 h for 3 days. Thereafter, omeprazole was given 20 mg per os (p.o.) once daily for 2 months. A pH meter was inserted in the fundus of each patient under fluoroscopic guidance after intravenous omeprazole had been administered. The occurrence of rebleeding episode was observed for 14 days.


RESULTS
In patients with H. pylori infection, intragastric pH (median, 95% confidence interval [CI]: 6.54, 5.90-6.68) was higher than in those without H. pylori infection (6.05, 5.59-6.50, p < 0.001). However, the patients with rebleeding (2 vs 3), volume of blood transfusion (median, range: 1000 ml, 0-2250 vs 750, 0-2000), number of operations (0 vs 1), mortality caused by bleeding (0 vs 0), and hospital stay (median, range: 6 days, 3-14 vs 7, 5-16) were not statistically different from those without H. pylori infection.


CONCLUSIONS
Omeprazole does increase intragastric pH in bleeding peptic ulcer patients with H. pylori infection. However, the presence of H. pylori infection does not affect the short-term rebleeding rate in these patients.
Lin
H J
HJ
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Tseng
G Y
GY
Hsieh
Y H
YH
Perng
C L
CL
Lee
F Y
FY
Chang
F Y
FY
Lee
S D
SD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D016001:Confidence Intervals; D004381:Duodenal Ulcer / Q000517:prevention & control / Q000601:surgery*; D004384:Duodenoscopy; D005260:Female; D005748:Gastric Fundus / Q000382:microbiology / Q000503:physiopathology; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control / Q000601:surgery*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000503:physiopathology*; D016480:Helicobacter pylori / Q000502:physiology*; D006489:Hemostatic Techniques; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D012008:Recurrence; D013276:Stomach Ulcer / Q000517:prevention & control / Q000601:surgery*; D015996:Survival Rate; D014510:Urease / Q000032:analysis
D000897:Anti-Ulcer Agents; D014510:Urease; D009853:Omeprazole