Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

Table 1 Forrest classification

1 Actively bleeding ulcer

1a: Spurting

1b: Oozing

2 Non-actively bleeding ulcer

2a: Non-bleeding visible vessel

2b: Ulcer with surface clot

2c: Ulcer with red or dark blue spots

3 Ulcer with clean base

Table 2 Demographic, clinical and endoscopic characteristics of all patients with bleeding from peptic ulcers after consumption of nonsteroidal anti-inflammatory drugs, grouped according to whether they did or did not have Helicobacter pylori infection n (%)

	Patients(n = 80)	Helicobacter pylori negative(n = 36)	Helicobacter pylori positive(n = 44)	P-value
Males	61 (76.3)	28 (77.8)	33 (75.0)	0.771
Age (yr) (mean ± SD)	61.2 ± 15.9	60.6 ± 18.3	61.7 ± 13.9	0.767
Smoker				0.703
Non-smoker	43 (53.8)	21 (58.3)	22 (50.0)
Current	26 (32.5)	10 (27.8)	16 (36.4)
Ex-smoker	11 (13.8)	5 (13.9)	6 (13.6)
Symptoms on presentation				0.721
Hematemesis	11 (13.8)	4 (11.1)	7 (15.9)
Melena	58 (72.5)	26 (72.2)	32 (72.7)
Hematemesis and melena	11 (13.8)	6 (16.7)	5 (11.4)
Initial mean hemoglobin (g/dL)	9.2 ± 2.3	8.7 ± 2.2	9.6 ± 2.4	0.076
American Society of Anesthesiology class				0.600
1-2	62 (77.5)	26 (72.2)	36 (81.8)
3	15 (18.8)	8 (22.2)	7 (15.9)
4	3 (3.8)	2 (5.6)	1 (2.3)
Complete Rockall score				0.183
0-2	39 (48.8)	19 (52.8)	20 (45.5)
3-5	34 (42.5)	12 (33.3)	22 (50)
6-8	7 (8.8)	5 (13.9)	2 (4.5)
1Comorbidity	27 (33.8)	12 (33.3)	15 (34.1)	0.943
Occasional consumption of NSAIDs	47 (58.8)	19 (52.8)	28 (63.6)	0.326
Patients on chronic LD ASA	33 (41.3)	17 (47.2)	16 (36.4)	0.326
Other antiplatelet drugs	5 (6.3)	2 (5.6)	3 (6.8)	0.999
Anticoagulants	2 (2.5)	2 (5.6)	0 (0)	0.199
Other drugs	39 (48.8)	15 (41.7)	24 (54.5)	0.252
Locations of ulcers				0.515
Duodenum alone	41 (51.3)	21 (58.3)	20 (45.5)
Stomach alone	29 (36.3)	11 (30.6)	18 (40.9)
Stomach and duodenum	10 (12.5)	4 (11.1)	6 (13.6)
Forrest				0.684
1a	2 (2.5)	1 (2.8)	1 (2.3)
1b	12 (15.0)	6 (16.7)	6 (13.6)
2a	4 (5.0)	1 (2.8)	3 (6.8)
2b	3 (3.8)	1 (2.8)	2 (4.6)
2c	16 (20.0)	10 (27.8)	6 (13.6)
3	43 (53.8)	17 (47.2)	26 (59.1)

NSAID: Nonsteroidal anti-inflammatory drug; LD ASA; Low dose aspirin.

¹According to the Charlson Comorbidity Index. Because of rounding, not all percentages total 100.

Table 3 Patients’ distribution on the basis of occasional or chronic consumption of nonsteroidal anti-inflammatory drugs

Occasional NSAID use
One NSAID	35 (43.8)
Two NSAIDs (in sequence)	9 (11.3)
Three NSAIDs (in sequence)	2 (2.5)
NSAID + ticlopidine	1 (1.3)
Chronic NSAID use
LD ASA alone	18 (22.5)
LD ASA + another NSAID1	8 (10.0)
LD ASA + two other NSAIDs (in sequence)1	1 (1.3)
LD ASA + ticlopidine	3 (3.8)
LD ASA + clopidogrel + NSAID1	1 (1.3)
LD ASA + LMWH	1 (1.3)
LD ASA + LMWH + 2 NSAIDs (in sequence)1	1 (1.3)

Data are expressed as number (percentage). NSAID: Non-steroidal antiinflammatory drug; LD ASA: Low dose aspirin; LMWH: Low-molecular-weight heparin.

¹NSAIDs consumed occasionally. Because of rounding, not all percentages total 100.

Table 4 Frequency of positive diagnostic tests for Helicobacter pylori in culture-positive or culture-negative patients

	Culture-positive(n = 38)	Culture-negative(n = 42)
CLO test + tissue section-positive	19 (23.8)	6 (7.5)
CLO test positive	5 (6.3)	9 (11.3)
Tissue section-positive	4 (5.0)	8 (10.0)

Data are expressed as number (percentage).

Table 5 Performance of tests for Helicobacter pylori infection

	Sensitivity% (95% CI)	Specificity% (95% CI)	PPV% (95% CI)	NPV% (95% CI)	Accuracy(%)	False positive(%)	False negative(%)
Culture of biopsy specimens	38/44	36/36	38/38	36/42	74/80	0/36	6/44
	86.4 (72.7-94.8)	100 (90.3-100)	100 (90.8-100)	85.7 (71.5-94.6)	-92.5	0	-13.6
Helicobacter pylori on tissue sections	29/44	28/36	29/37	28/43	57/80	8/36	15/44
	65.9 (50.1-79.5)	77.8 (60.9-89.9)	78.4 (61.8-90.2)	65.1 (49.1-79.0)	-71.3	-22.2	-34.1
Rapid urease test	30/44	27/36	30/39	27/41	57/80	9/36	14/44
	68.2 (52.4-81.4)	75.0 (57.8-87.9)	76.9 (60.7-88.9)	65.9 (49.4-79.9)	-71.3	-25	-31.8
Helicobacter pylori on tissue sections and rapid urease test	25/44	36/36	25/25	36/55	61/80	0/36	19/44
	56.8 (41.0-71.7)	100 (90.3-100)	100 (86.3-100)	65.5 (51.4-77.8)	-76.3	0	-43.2
Anti-CagA	26/44	26/36	26/36	26/44	52/80	10/26	18/44
	59.1 (43.3-73.7)	72.2 (54.8-85.8)	72.2 (54.8-85.8)	59.1 (43.3-73.7)	-65	-38.5	-40.9

CI: Confidence interval; NPV: Negative predictive value; PPV: Positive predictive value.