title: Clinical characteristics of Helicobacter pylori-negative drug-negative peptic ulcer bleeding.
abstract: OBJECTIVE
  To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori (H. pylori)-negative and drug-negative] peptic ulcer bleeding (PUB).
  
  
  METHODS
  A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed. A total of 232 patients were enrolled in this study. The patients were divided into four groups according to the etiologies of PUB: idiopathic, H. pylori-associated, drug-induced and combined (H. pylori-associated and drug-induced) types. We compared the clinical characteristics and outcomes between the groups. When the silver stain or rapid urease tests were H. pylori-negative, we obtained an additional biopsy specimen by endoscopic re-examination and performed an H. pylori antibody test 6-8 wk after the initial endoscopic examination. For a diagnosis of idiopathic PUB, a negative result of an H. pylori antibody test was confirmed. In all cases, re-bleeding was confirmed by endoscopic examination. For the risk assessment, the Blatchford and the Rockall scores were calculated for all patients.
  
  
  RESULTS
  For PUB, the frequency of H. pylori infection was 59.5% (138/232), whereas the frequency of idiopathic cases was 8.6% (20/232). When idiopathic PUB was compared to H. pylori-associated PUB, the idiopathic PUB group showed a higher rate of re-bleeding after initial hemostasis during the hospital stay (30% vs 7.4%, P = 0.02). When idiopathic PUB was compared to drug-induced PUB, the patients in the idiopathic PUB group showed a higher rate of re-bleeding after initial hemostasis upon admission (30% vs 2.7%, P < 0.01). When drug-induced PUB was compared to H. pylori-associated PUB, the patients in the drug-induced PUB were older (68.49 ± 14.76 years vs 47.83 ± 15.15 years, P < 0.01) and showed a higher proportion of gastric ulcer (77% vs 49%, P < 0.01). However, the Blatchford and the Rockall scores were not significantly different between the two groups. Among the patients who experienced drug-induced PUB, no significant differences were found with respect to clinical characteristics, irrespective of H. pylori infection.
  
  
  CONCLUSIONS
  Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission. Therefore, these patients need to undergo close surveillance upon admission.
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Woo Chul
authors.initials: WC
authors.lastname: Chung
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Jeon
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Dae Bum
authors.initials: DB
authors.lastname: Kim
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Hea Jung
authors.initials: HJ
authors.lastname: Sung
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Yeon-Ji
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Lim
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Min-Ah
authors.initials: MA
authors.lastname: Kim
authors.affiliation: Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D001706:Biopsy; D001944:Breath Tests; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology; D016480:Helicobacter pylori / Q000472:pathogenicity; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: Gastrointestinal bleeding; Helicobacter pylori; Non-steroidal anti-inflammatory drug; Peptic ulcer