Low seroprevalence of Helicobacter pylori infection in patients with stress ulcer bleeding--a prospective evaluation of patients on a cardiosurgical intensive care unit.
OBJECTIVE
The pathogenesis of stress ulceration in seriously ill patients is uncertain and the pathogenic role of Helicobacter pylori infection is unknown. We therefore assessed the seroprevalence of patients of a cardiosurgical intensive care unit (ICU) with clinically important stress ulcer bleeding. We compared this prevalence with a control group matched for this kind of surgical intervention, missing history of peptic ulcer disease, age and gender.


METHODS
Prospective survey.


METHODS
Cardiosurgical ICU in a university teaching hospital.


METHODS
Two thousand five hundred seventy cardiosurgical patients with intravenous ranitidine stress ulcer prophylaxis were screened for clinically important stress ulcer bleeding. Helicobacter pylori seropositivity was measured in all patients with a clinically important bleeding and in a control group of 245 consecutive cardiosurgical patients, matched for the kind of cardiosurgical intervention, age and gender.


RESULTS
In 56 of 2,570 (2.1%) patients signs of clinically important bleeding were seen. Endoscopical examination revealed stress ulcer bleeding in 42 cases. The incidence of stress ulcer bleeding was 1.6%. The seropositivity of the group with ulcer bleeding was 45.2 % whereas 62.4 % of the patients in the control group were Helicobacter pylori positive (p = 0.08).


CONCLUSIONS
Our results suggest that the Helicobacter pylori infection does not play a pathogenic role in stress ulcer bleeding. Prophylactic cure of Helicobacter pylori can not be recommended in this setting.
Department of Internal Medicine C, Klinikum der Stadt Ludwigshafen, Academic Medical Hospital of the Johannes-Gutenberg-University of Mainz, Rhine, Germany. MedCLu@t-online.de
D
D
Schilling
G
G
Haisch
N
N
Sloot
R
R
Jakobs
W
W
Saggau
J F
JF
Riemann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D016480:Helicobacter pylori; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000382:microbiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D016036:Seroepidemiologic Studies; D013315:Stress, Psychological / Q000150:complications