Peptic ulcer disease in dyspeptic patients with ischemic heart disease: search and treat?
OBJECTIVE
The aim of this study was to determine the prevalence and risk factors for peptic ulcer disease (PUD) in dyspeptic patients with ischemic heart disease (IHD), and to assess whether the healing of PUD before coronary artery bypass grafting (CABG) could reduce the need for urgent postoperative endoscopy.


METHODS
A series of 894 patients referred to Dubrava University Hospital in Zagreb for elective CABG during the period from May 1998 until April 2001 was prospectively analysed. Dyspepsia was assessed by a questionnaire, PUD by upper gastrointestinal endoscopy, and H. pylori status by histology/Giemsa staining and the rapid urease test. The need for urgent postoperative endoscopy (hematemesis and/or melena, sudden onset of anemia or unexplained epigastric pain) was compared between the prospective study group of 894 patients and a series of 463 patients referred for CABG to Dubrava University Hospital during the period from January 1997 until April 1998.


RESULTS
Gastroduodenal dyspepsia predominated in 184 (20.6 %) patients, 142 (77.2 %) of them with Helicobacter (H.) pylori infection and 69 (37.5 %) with verified PUD. Univariate analysis indicated the increased risk of multiple PUD to be related to a previous diagnosis of PUD (OR 3.61, 95 % CI 1.32 - 9.82), H. pylori infection (OR 18.86, 95 % CI 2.31 - 153.98), use of aspirin (OR 5.70; 95 % CI 1.80 - 18.03) and left coronary artery occlusions (3.10, 95 % CI 1.00 - 9.59). Multivariate analysis pointed to H. pylori infection (OR 16.30, 95 % CI 1.57 - 168.53) and left coronary artery occlusions (OR 4.84, 95 % CI 1.05 - 22.30) as independent risk factors for multiple PUD. The OR for urgent postoperative endoscopy due to a major gastrointestinal event was 9.9 (95 % CI 2.2 - 45.1) and the OR for active peptic ulcer with stigmata of recent bleeding was 6.9 (95 % CI 1.4 - 33.1) in the group of patients with IHD who were not submitted to evaluation for dyspepsia prior to elective heart surgery.


CONCLUSIONS
In areas with a high prevalence of H. pylori infection, endoscopy and a "search and treat" strategy for IHD patients with dyspepsia before elective cardiac surgery should significantly reduce the need for urgent postoperative endoscopy due to major gastrointestinal events.
Department of Gastroenterology, University Department of Medicine, Dubrava University Hospital, Zagreb, Croatia. mbanic@kbd.hr
M
M
Banić
Z
Z
Sutlić
B
B
Biocina
M
M
Kujundzić
D
D
Fabijanić
N
N
Ljubicić
S
S
Plesko
M
M
Buljevac
D
D
Kardum
Z
Z
Cabrijan
I
I
Grgurević
M
M
Urek
M
M
Tadić
V
V
Hulak
M
M
Petrovecki
V
V
Bedenikovic
B
B
Starcević
I
I
Rotkvić
D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D017523:Croatia / Q000453:epidemiology; D004415:Dyspepsia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005773:Gastroscopy / Q000706:statistics & numerical data; D006801:Humans; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000601:surgery*; D010437:Peptic Ulcer / Q000175:diagnosis / Q000601:surgery*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome