title: Peptic ulcer bleeding: is Helicobacter pylori a risk factor in an endemic area?
abstract: OBJECTIVE
  A high prevalence of Helicobacter pylori infection has been reported in Iran. Although the importance of H. pylori in the induction of peptic ulcer disease is clearly defined, only few studies have addressed its role in bleeding from peptic ulcers. We evaluated the role of H. pylori in peptic ulcer bleeding.
  
  
  METHODS
  Patients with acute peptic ulcer bleeding (PUB) and those with peptic ulcer disease without bleeding ('controls') were enrolled. Upper GI endoscopy and rapid urease test were performed in both groups. Histological study for detection of H. pylori was performed in patients with active bleeding, if RUT was negative. Other variables evaluated included sex, age, smoking, previous history of bleeding, non-steroidal anti-inflammatory drugs use, ulcer size, ulcer location, and duration of acid-peptic disease. Multivariate logistic regression analysis was performed to identify independent risk factors.
  
  
  RESULTS
  161 patients with PUB and 287 control patients were enrolled. H. pylori infection was seen more frequently in patients with duodenal ulcer than gastric ulcer (88.9% vs. 60.5%, p< 0.001). Univariate analysis showed that patients with PUB were more often male, older in age, used NSAID, had history of PUB in the past, had ulcer located in the stomach and not in the duodenum, and more often had large ulcer (>1 cm). Logistic regression analysis showed that H. pylori infection was protective in PUB after controlling for confounders (OR 0.41, 95% CI 0.21-0.79), when ulcer location was not entered in the model. A second model including ulcer location (to test for a residual effect) showed that H. pylori infection was not a significant risk factor in PUB (OR 0.61, 95% CI 0.30-1.24).
  
  
  CONCLUSIONS
  H. pylori may not be an independent factor in bleeding from peptic ulcers. The lower frequency of this infection in these patients can be described by the higher frequency of bleeding from gastric ulcers, which are less H. pylori related compared with duodenal ulcer.
authors.affiliation: Digestive Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran. sotoudehmanesh@ddrcir.org
authors.forename: Rasoul
authors.initials: R
authors.lastname: Sotoudehmanesh
authors.forename: Ali Ali
authors.initials: AA
authors.lastname: Asgari
authors.forename: Hafez Tirgar
authors.initials: HT
authors.lastname: Fakheri
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
authors.forename: Morteza
authors.initials: M
authors.lastname: Khatibian
authors.forename: Nahid
authors.initials: N
authors.lastname: Shirazian
mesh_terms: D000328:Adult; D019353:Endemic Diseases; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000382:microbiology*; D012307:Risk Factors