An observational study of upper gastrointestinal bleeding in intensive care units: is Helicobacter pylori the culprit?
OBJECTIVE
Upper gastrointestinal bleeding (UGIB) related to stress ulcers was formerly a fearsome complication of intensive care. The incidence of this event has decreased over the years. However, the morbidity, mortality, and causes of UGIB, particularly the etiologic role of Helicobacter pylori infection, are still controversial. Therefore, we prospectively assessed the incidence of UGIB in the intensive care unit (ICU) and evaluated the role of H. pylori infection.


METHODS
A prospective observational study followed by a case-control study.


METHODS
Seven ICUs in the Paris area, five of them located in teaching hospitals.


METHODS
All patients admitted consecutively to seven ICUs during a 1-year period were monitored for signs of clinically relevant UGIB.


METHODS
None.


RESULTS
Only cases of endoscopically confirmed UGIB were analyzed. Patients whose hemorrhage originated from the stomach and/or duodenum were tested for H. pylori infection, by means of serology, histologic examination, and stool antigen detection. The possible association between H. pylori and UGIB was examined in a case-control study. Twenty-nine of the 4,341 patients admitted to the seven ICUs during the study period had clinically relevant, endoscopically confirmed UGIB (incidence, 0.67%; 95% confidence interval, 0.56%-0.77%). Ulcers were most frequently observed endoscopically. Patients who bled had a higher Simplified Acute Physiology Score (SAPS II) at admission (mean +/- sd, 47 +/- 14 vs. 36 +/- 28; p < .001). Despite a higher in-ICU mortality rate among patients who bled (73% vs. 16%; p < .001), death was never due to bleeding. H. pylori infection was more frequent in patients who bled than in matched controls (36% vs. 16%; p = .04).


CONCLUSIONS
Clinically relevant, endoscopically confirmed UGIB is a rare event in the ICU setting and tends to occur in severely ill patients. H. pylori infection is more frequent in patients with gastroduodenal hemorrhage than in nonbleeding patients.
Maury
Eric
E
Service de Réanimation Médicale, Unité Inserm U444, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Tankovic
Jacques
J
Ebel
Anne
A
Offenstadt
Georges
G
D016022:Case-Control Studies; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D013312:Stress, Physiological