Title: Adherence to Helicobacter pylori Testing After Hospitalization for Bleeding Peptic Ulcer Disease
Abstract: Introduction: Guidelines recommend H. pylori testing in patients with bleeding peptic ulcers. Studies have shown that H. pylori eradication after ulcer bleeding lowers the rebleeding rate. The aim of this study was to assess adherence to H. pylori testing for bleeding peptic ulcers and to evaluate whether H. pylori identification altered rebleeding risk among patients hospitalized for bleeding ulcers. Methods: We examined all inpatients at our institution who underwent endoscopy between 2011 and 2016 for suspected upper GI bleeding with findings of gastric or duodenal ulcers. H. pylori testing at the time of index endoscopy was defined as gastric biopsy during endoscopy, or as stool H. pylori antigen or H. pylori antibody testing within 60 days of endoscopy. H. pylori breath testing was not available during the study period. The primary outcome was rebleeding within 1 year, defined as: (1) decrease in hemoglobin by ≥2 mg/dL compared to the pre-index endoscopy hemoglobin or (2) performance of a repeat upper endoscopy with an indication of bleeding. We used a multivariable logistic regression model to assess predictors of failure to test for H. pylori. We also examined the relationship between H. pylori testing and subsequent risk for rebleeding using Cox proportional hazards modeling. Results: Among 976 patients who underwent upper endoscopy for bleeding and had a gastric or duodenal ulcer, 78% were tested for H. pylori within 60 days of the index endoscopy. Significant differences existed between patients who were and were not tested for H. pylori with regards to sex, INR, albumin, platelets, and ICU admission at time of index endoscopy (Table 1). Of these, ICU location was the most significant predictor with only 38% of ICU patients undergoing H. pylori testing compared to 73% non-ICU patients (p < 0.01). H. pylori testing was associated with a 50% reduction in rebleeding risk compared to those without H. pylori testing, after controlling for other factors (Table 2, Figure 1).1088_A Figure 1. Baseline characteristics, stratified by H. pylori testing status.Conclusion: Patients were less likely to undergo H. pylori testing after ulcer bleeding if the index endoscopy was performed in the ICU. Testing for H. pylori after ulcer bleeding was associated with a significantly lower risk of rebleeding within 1 year. Given the benefit in rebleeding risk, biopsy should be strongly considered during upper endoscopy for bleeding ulcers if noninvasive H. pylori testing has been difficult to obtain in the past. This may be especially true in the ICU.1088_B Figure 2. Cox Proportional Hazards Model of Risk of Rebleeding1088_C Figure 3. Kaplan-Meier Curve of Time to Rebleeding or Death
Publication Year: 2018
Publication Date: 2018-10-01
Language: en
Type: article
Indexed In: ['crossref']
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