Occurrence and relapse of bleeding from duodenal ulcer: respective roles of acid secretion and Helicobacter pylori infection.
BACKGROUND
Helicobacter pylori infection, gastric acid hypersecretion and NSAID consumption may cause peptic ulcer.


OBJECTIVE
To investigate the respective roles of H. pylori and acid secretion in bleeding duodenal ulcer.


METHODS
A total of 99 duodenal ulcer patients were referred for evaluation of acid secretion: seven with Zollinger-Ellison Syndrome; 14 with hypersecretory duodenal ulcer, defined by the coexistence of elevated basal acid output and pentagastrin acid output; and 78 duodenal ulcer patients with normal acid output. All non-Zollinger-Ellison Syndrome patients were H. pylori-positive and cured of infection. All patients were followed-up for a 36-month period, to assess the occurrence of bleeding episodes.


RESULTS
Twenty-nine patients had at least one bleeding episode in the 4 years before the study. Bleeding was more frequent in males and in patients on NSAIDs. The mean basal acid output was not higher among bleeders. In the 21 patients (14 hypersecretory duodenal ulcer, seven Zollinger-Ellison Syndrome) with basal acid output > 10 meg/h and pentagastrin acid output > 44.5 meg/h, the risk of bleeding was higher (OR 6.5; 95% CI: 2-21). In the follow-up period, three out of 83 (3.3%) non-Zollinger-Ellison Syndrome patients had a H. pylori-negative duodenal ulcer with bleeding. The risk of bleeding after H. pylori cure was not higher in hypersecretory duodenal ulcer patients (P > 0.3), nor among patients with previous bleeding episodes (P > 0.2).


CONCLUSIONS
In H. pylori-positive duodenal ulcer patients, the coexistence of elevated basal acid output and pentagastrin acid output leads to a sixfold increase in the risk of bleeding. After H. pylori cure, gastric acid hypersecretion is not a risk factor for bleeding. However, duodenal ulcer recurrence with bleeding may occasionally occur in patients cured of H. pylori, even if acid output is normal.
Capurso
G
G
Digestive and Liver Diseases Unit, II Medical School, Rome, Italy Istituto di Igiene G Sanarelli, University La Sapienza, Rome, Italy.
Annibale
B
B
Osborn
J
J
D'Ambra
G
G
Martino
G
G
Lahner
E
E
Delle Fave
G
G
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004381:Duodenal Ulcer / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D015043:Zollinger-Ellison Syndrome / Q000150:complications* / Q000382:microbiology / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal