title: Long-term follow-up of 1,000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding.
abstract: OBJECTIVE
  To evaluate the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients.
  
  
  METHODS
  Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or (13)C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by (13)C-urea breath test 8 weeks after completing therapy. Patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test. NSAID use was not permitted during follow-up.
  
  
  RESULTS
  Thousand patients were followed up for at least 12 months, with a total of 3,253 patient-years of follow-up. Mean age 56 years, 75% males, 41% previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in three patients at 1 year (which occurred after NSAID use in two cases, and after H. pylori reinfection in another one), and in two more patients at 2 years (one after NSAID use and another after H. pylori reinfection). The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16-1.16%), and the incidence rate of rebleeding was 0.15% (0.05-0.36%) per patient-year of follow up.
  
  
  CONCLUSIONS
  Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients.
authors.affiliation: Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain. gisbert@meditex.es
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: X
authors.initials: X
authors.lastname: Calvet
authors.forename: A
authors.initials: A
authors.lastname: Cosme
authors.forename: P
authors.initials: P
authors.lastname: Almela
authors.forename: F
authors.initials: F
authors.lastname: Feu
authors.forename: F
authors.initials: F
authors.lastname: Bory
authors.forename: S
authors.initials: S
authors.lastname: Santolaria
authors.forename: R
authors.initials: R
authors.lastname: Aznárez
authors.forename: M
authors.initials: M
authors.lastname: Castro
authors.forename: N
authors.initials: N
authors.lastname: Fernández
authors.forename: R
authors.initials: R
authors.lastname: García-Grávalos
authors.forename: A
authors.initials: A
authors.lastname: Benages
authors.forename: N
authors.initials: N
authors.lastname: Cañete
authors.forename: M
authors.initials: M
authors.lastname: Montoro
authors.forename: F
authors.initials: F
authors.lastname: Borda
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Aisa
authors.forename: J M
authors.initials: JM
authors.lastname: Piqué
mesh_terms: D001944:Breath Tests; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000382:microbiology; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology*; D012008:Recurrence; D014508:Urea / Q000032:analysis
chemical_list: D014508:Urea