title: High incidence of mortality and recurrent bleeding in patients with Helicobacter pylori-negative idiopathic bleeding ulcers.
abstract: OBJECTIVE
  The long-term prognosis of peptic ulcers associated with neither Helicobacter pylori nor nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown.
  
  
  METHODS
  This 7-year prospective cohort study recruited patients with bleeding ulcers from January to December 2000. H pylori-negative idiopathic bleeding ulcers were defined as having tested negative for H pylori, having no exposure to aspirin or analgesics within 4 weeks before endoscopy, and having no other identifiable causative factors. After ulcers healed, patients were divided into 2 groups: patients with prior H pylori-negative idiopathic bleeding ulcers (H pylori-negative idiopathic ulcer cohort; n = 120) and those with H pylori-positive, NSAID-negative bleeding ulcers who received eradication therapy (H pylori ulcer cohort; n = 213). Both groups were followed for <or=7 years without gastroprotective therapy. The primary endpoints were recurrent ulcer bleeding and mortality.
  
  
  RESULTS
  The 7-year cumulative incidence of recurrent ulcer bleeding was 42.3% (95% CI, 36.5%-48.1%) in the H pylori-negative idiopathic ulcer cohort and 11.2% (95% CI, 8.8%-13.6%) in the H pylori ulcer cohort (a difference of 31.1%; 95% CI, 27.7%-34.5%; P < .0001). Significantly more patients died in the H pylori-negative idiopathic ulcer cohort (87.6%; 95% CI, 83.0%-92.2%) than in the H pylori ulcer cohort (37.3%; 95% CI, 34.0%-40.6%) with a difference of 50.3% (95% CI, 49.0%-51.6%; P < .0001).
  
  
  CONCLUSIONS
  Patients with history of H pylori-negative idiopathic bleeding ulcers have a high risk of recurrent ulcer bleeding and mortality.
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.forename: Yawen
authors.initials: Y
authors.lastname: Chan
authors.forename: Jessica Yuet-Ling
authors.initials: JY
authors.lastname: Ching
authors.forename: Kim
authors.initials: K
authors.lastname: Au
authors.forename: Aric Josun
authors.initials: AJ
authors.lastname: Hui
authors.forename: Larry Hin
authors.initials: LH
authors.lastname: Lai
authors.forename: Dorothy Kai-Lai
authors.initials: DK
authors.lastname: Chow
authors.forename: Danny Ka-Fai
authors.initials: DK
authors.lastname: Siu
authors.forename: Yan-Ni
authors.initials: YN
authors.lastname: Lui
authors.forename: Justin Che-Yuen
authors.initials: JC
authors.lastname: Wu
authors.forename: Ka-Fai
authors.initials: KF
authors.lastname: To
authors.forename: Lawrence Cheung-Tsui
authors.initials: LC
authors.lastname: Hung
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
authors.forename: Joseph Jao-Yiu
authors.initials: JJ
authors.lastname: Sung
authors.forename: Francis Ka-Leung
authors.initials: FK
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality*; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications* / Q000175:diagnosis; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D055815:Young Adult