Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. Methods: We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Results: Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. Conclusions: H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.
Abstract
Background/Aims: The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. Methods: We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Results: Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. Conclusions: H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.
참고문헌 (24)
- Laine L, "Bleeding peptic ulcer", N Engl J Med, 331, pp.717~727 (1994)
- NIH Consensus Conference, "Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease", JAMA, 272, pp.65~69 (1994)
- Chen TS, "Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro-duodenal ulcer diseases in Taiwan", J Gastroenterol Hepatol, 25, pp.919~922 (2010)
- Hopkins RJ, "Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review", Gastroenterology, 110, pp.1244~1252 (1996)
- Sanchez-Delgado J, "Has H. pylori prevalence in bleeding peptic ulcer been underestimated? A meta-regression", Am J Gastroenterol, 106, pp.398~405 (2011)
- Lee JM, "Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding", Am J Gastroenterol, 95, pp.1166~1170 (2000)
- Gisbert JP, "Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis", Am J Gastroenterol, 101, pp.848~863 (2006)
- Hermansson M, "Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002", BMC Gastroenterol, 9, pp.25~ (2009)
- Hippisley-Cox J, "Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis", BMJ, 331, pp.1310~1316 (2005)
- McColl KE, "How I manage H. pylori-negative, NSAID", aspirin-negative peptic ulcers, 2009, pp.104, 190~193
- Cheng SH, "The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment", JAMA, 278, pp.89~93 (1997)
- Nozaki K, "Effect of early eradication on Helicobacter pylori-related gastric carcinogenesis in Mongolian gerbils", Cancer Sci, 94, pp.235~239 (2003)
- Wu CY, "Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease", Gastroenterology, 137, pp.1641~1648 (2009)
- Cameron EA, "Long-term study of re-infection following successful eradication of Helicobacter pylori infection", Aliment Pharmacol Ther, 23, pp.1355~1358 (2006)
- Working Party of the European Helicobacter pylori Study Group, "Technical annex: tests used to assess Helicobacter pylori infection", Gut, 41(2), pp.S10~S18 (1997)
- Working Party of the European Helicobacter pylori Study Group, "Guidelines for clinical trials in Helicobacter pylori infection", Gut, 41(2), pp.S1~S9 (1997)
- Bianchi Porro G, "The conflicting relationship between Helicobacter pylori and non-steroidal anti-inflammatory drugs in peptic ulcer bleeding", Scand J Gastroenterol, 34, pp.225~228 (1999)
- Liou JM, "Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial", Lancet, 381, pp.205~213 (2013)
- Lo GH, "The effects of eradication of Helicobacter pylori on the recurrence of duodenal ulcers in patients with cirrhosis", Gastrointest Endosc, 62, pp.350~356 (2005)
- Tseng GY, "Recurrence of peptic ulcer in uraemic and non-uraemic patients after Helicobacter pylori eradication: a 2-year study", Aliment Pharmacol Ther, 26, pp.925~933 (2007)
- Chang SS, "Helicobacter pylori is not the predominant etiology for liver cirrhosis patients with peptic ulcer disease", Eur J Gastroenterol Hepatol, 25, pp.159~165 (2013)
- Kang JY, "Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection", J Gastroenterol Hepatol, 14, pp.771~778 (1999)
- Chan FK, "Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers", Lancet, 350, pp.975~979 (1997)
- Malfertheiner P, "Management of Helicobacter pylori infection: the Maastricht IV", Florence Consensus Report, 2012, pp.61, 646~664