Evidence-Based Medicine
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2497-2503
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2497
Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding
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
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
Author contributions: Yoon H and Lee DH were responsible for conception, design of the study, analysis and interpretation of data, and wrote the manuscript; Jang ES, Kim J, Shin CM, Park YS, Hwang J, Kin J, Jeong S and Kim N critically revised the article for important intellectual content; all the authors reviewed and approved the final version to be published.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Ho Lee, MD, Departments of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea. dhljohn@yahoo.co.kr
Telephone: +82-31-7877006 Fax: +82-31-7874051
Received: July 29, 2014
Peer-review started: July 31, 2014
First decision: August 15, 2014
Revised: September 1, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: February 28, 2015
Processing time: 213 Days and 18.3 Hours
Abstract

AIM: 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].

CONCLUSION: 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.

Keywords: Helicobacter pylori; Peptic ulcer hemorrhage; Disease eradication; Hospitalization; Patient discharge

Core tip: This study aimed to determine the optimal time to initiate Helicobacter pylori (H. pylori) eradication in patients hospitalized with peptic ulcer bleeding. There was no significant difference in the H. pylori eradication rate between patients who received eradication therapy during hospitalization and those who commenced therapy as outpatients. However, because many patients who were discharged before H. pylori infection was confirmed lost the opportunity to begin eradication therapy, H. pylori infection should be confirmed and eradication therapy started in patients with peptic ulcer bleeding prior to discharge.