Suppression of Helicobacter pylori infection during intensive care stay: related to stress ulcer bleeding incidence?
OBJECTIVE
To assess the prevalence of active Helicobacter pylori infection in patients admitted to the intensive care unit, to determine the effect of selective gut decontamination on the persistence of this organism, and to explore the possible relationship between H. pylori infection and stress ulcer bleeding incidence.


METHODS
We determined in a prospective observational study of 300 consecutive, mechanically ventilated patients the activity of H. pylori infection and the incidence of stress ulcer-related upper gastrointestinal bleeding over time. H. pylori infection was detected by Laser-Assisted Ratio Analyzer (LARA)- (13)C-urea breath test (Alimenterics, Inc., NJ) and serology. Stress ulcer prophylaxis was not prescribed. Endoscopy was performed in cases of upper gastrointestinal bleeding.


RESULTS
The prevalence of active H. pylori infection on admission was 38% as detected by urea breath test, and declined to 8% on the third day, and to 0% on the seventh day after admission as a result of antibiotic treatment. Stress ulcer-related upper gastrointestinal bleeding occurred in 1.0% (3 of 300) of the patients; none were infected with H. pylori on admission or at the time of bleeding.


CONCLUSIONS
H. pylori infection monitored by LARA- (13)C-urea breath test was rapidly suppressed during intensive care treatment, which can be explained by the routine use of antibiotics for gut decontamination.The low incidence of stress ulcer-related bleeding might be related to the prevention of H. pylori-associated stress lesions by effective suppression of this microorganism, but further studies are warranted to test this hypothesis.
van der Voort
P H
PH
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
van der Hulst
R W
RW
Zandstra
D F
DF
Geraedts
A A
AA
van der Ende
A
A
Tytgat
G N
GN
D001944:Breath Tests; D016099:Endoscopy, Gastrointestinal; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D010438:Peptic Ulcer Hemorrhage / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D013315:Stress, Psychological / Q000150:complications*