Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding.
OBJECTIVE
To evaluate when Helicobacter pylori (H. pylori) eradication therapy (ET) should be started in patients with peptic ulcer bleeding (PUB).


METHODS
Clinical data concerning adults hospitalized with PUB were retrospectively collected and analyzed. Age, sex, type and stage of peptic ulcer, whether endoscopic therapy was performed or not, methods of H. pylori detection, duration of hospitalization, and specialty of the attending physician were investigated. Factors influencing the confirmation of H. pylori infection prior to discharge were determined using multiple logistic regression analysis. The H. pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.


RESULTS
A total of 232 patients with PUB were evaluated for H. pylori infection by histology and/or rapid urease testing. Of these patients, 53.7% (127/232) had confirmed results of H. pylori infection prior to discharge. In multivariate analysis, duration of hospitalization and ulcer stage were factors independently influencing whether H. pylori infection was confirmed before or after discharge. Among the patients discharged before confirmation of H. pylori infection, 13.3% (14/105) were lost to follow-up. Among the patients found to be H. pylori-positive after discharge, 41.4% (12/29) did not receive ET. There was no significant difference in the H. pylori eradication rate between patients who received ET during hospitalization and those who commenced ET as outpatients [intention-to-treat: 68.8% (53/77) vs 60% (12/20), P=0.594; per-protocol: 82.8% (53/64) vs 80% (12/15), P=0.723].


CONCLUSIONS
Because many patients with PUB who were discharged before H. pylori infection status was confirmed lost an opportunity to receive ET, we should confirm H. pylori infection and start ET prior to discharge.
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Hyuk
H
Yoon
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Dong Ho
DH
Lee
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Eun Sun
ES
Jang
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Jaihwan
J
Kim
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Cheol Min
CM
Shin
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Young Soo
YS
Park
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Jin-Hyeok
JH
Hwang
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Jin-Wook
JW
Kim
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Sook-Hayng
SH
Jeong
Hyuk Yoon, Dong Ho Lee, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Departments of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea.
Nayoung
N
Kim
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D010437:Peptic Ulcer / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
Disease eradication; Helicobacter pylori; Hospitalization; Patient discharge; Peptic ulcer hemorrhage