title: More favorable outcomes with peptic ulcer bleeding due to Helicobacter pylori.
abstract: BACKGROUND
  Acute upper gastrointestinal bleeding is a common complication of peptic ulcer disease, often caused by Helicobacter pylori and nonsteroidal anti-inflammatory drug (NSAID) use. The purpose of this study was to determine whether the cause and biologic behavior of ulcers associated with acute upper gastrointestinal bleeding might lead to divergent patient outcomes.
  
  
  METHODS
  In this Institutional Review Board-approved study, we compared clinical features and outcomes of patients with acute upper gastrointestinal bleeding due to ulcers categorized into 4 groups: Helicobacter pylori positive or negative combined with NSAID usage positive or negative. Likelihood chi-squared analyses were utilized for group comparisons and stepwise multiple logistic regression models were utilized to determine which factors were related to bleeding outcomes.
  
  
  RESULTS
  Of 2242 patients with upper gastrointestinal bleeding, 575 (26%) had gastroduodenal ulcer disease, and of those with appropriate diagnostic testing, approximately half (228, 10% overall) had evidence of Helicobacter pylori infection and half (216, 10% overall) had no evidence of Helicobacter pylori infection. Patients without Helicobacter pylori infection had significantly more comorbid conditions than those with Helicobacter pylori and higher Charlson Index comorbidity scores (2.6 ± 2.6 [mean and SD] vs 1.9 ± 2.3, P = .003). Hospital length of stay was significantly longer for Helicobacter pylori-negative patients (mean 11.4 ± 21.7 vs 6 ± 8.5 days and median 5.5 vs 3 days, P <.001 and <.001, respectively). Rebleeding events within 30 days were more frequent in Helicobacter pylori-negative patients than Helicobacter pylori-positive patients (11% vs 5%, P = .009). Rebleeding was most frequent in patients without Helicobacter pylori and with no reported use of NSAIDS (18%, P = .01).
  
  
  CONCLUSIONS
  Helicobacter pylori-negative ulcers were associated with poorer outcomes regardless of use of NSAIDs. Patients with ulcers negative for Helicobacter pylori and no history of NSAID use had the worst outcomes and had more severe systemic disease.
authors.affiliation: Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Memorial Hospital, Dallas, TX, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Chason
authors.forename: Joan S
authors.initials: JS
authors.lastname: Reisch
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000401:mortality; D016480:Helicobacter pylori; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology* / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Helicobacter pylori; Hemorrhage; Nonsteroidal anti-inflammatory drugs; Peptic ulcer disease; Upper gastrointestinal