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HasH. pyloriPrevalence in Bleeding Peptic Ulcer Been Underestimated? A Meta-Regression

Sánchez-Delgado, Jordi MD1,2; Gené, Emili MD, PhD2,3; Suárez, David PhD4; García-Iglesias, Pilar MD1; Brullet, Enric MD1,2; Gallach, Marta MD1; Feu, Faust MD, PhD2,5; Gisbert, Javier P MD, PhD2,6; Calvet, Xavier MD, PhD1,2

American Journal of Gastroenterology: March 2011 - Volume 106 - Issue 3 - p 398–405
doi: 10.1038/ajg.2011.2
REVIEW: CLINICAL AND SYSTEMATIC REVIEWS
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OBJECTIVES: It has been suggested that prevalence ofHelicobacter pylori(Hp) in peptic ulcer bleeding (PUB) is lower than that in non-complicated ulcers. AsHpinfection is elusive in PUB, we hypothesized that this low prevalence could be related to an insufficiently intensive search for the bacteria. The aim of the study was to evaluate whether the prevalence ofHpin PUB depends on the diagnostic methods used in a given study.

METHODS: A systematic review was performed of studies assessing the prevalence ofHpinfection in patients with PUB. Data were extracted in duplicate. Univariate and multivariate random-effects meta-regression analyses were performed to determine the factors that explained the differences inHpprevalence between studies.

RESULTS: The review retrieved 71 articles, including 8,496 patients. The mean prevalence ofHpinfection in PUB was 72%. The meta-regression analysis showed that the most significant variables associated with a high prevalence ofHpinfection were the use of a diagnostic test delayed until at least 4 weeks after the PUB episode—odds ratio: 2.08, 95% confidence interval: 1.10–3.93,P=0.024—and a lower mean age of patients—odds ratio: 0.95 per additional year, 95% confidence interval: 0.92–0.99,P=0.008.

CONCLUSIONS: Studies that performed a delayed test and those including younger patients found a higher prevalence ofHp, approaching that recorded in cases of non-bleeding ulcers. These results suggest that the low prevalence ofHpinfection described in PUB may be related to the methodology of the studies and to patients' characteristics, and that the true prevalence ofHpin PUB is still to be determined. Our data also support the recent recommendations of the International Consensus on Non-Variceal Upper Gastrointestinal Bleeding regarding the performance of a delayed diagnostic test whenHptests carried out during the acute PUB episode are negative.

1Digestive Diseases Unit, Hospital de Sabadell, Institut Universitari Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain

2Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain

3Emergency Unit, Hospital de Sabadell, Sabadell, Spain

4Unitat d'Epidemiologia i Avaluació, Fundació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain

5Servei de Gastroenterologia, Institut de Malalties Digestives, Hospital Clínic de Barcelona, Barcelona, Spain

6Servicio de Aparato Digestivo, Hospital de la Princesa, Madrid, Spain

Correspondence: Xavier Calvet, MD, Unitat de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autónoma de Barcelona, CIBEREHD—Instituto de Salud Carlos III, Parc Taulí, 1, 08208 Sabadell (Barcelona), Spain. E-mail: xcalvet@tauli.cat

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A694

Received 19 October 2010; accepted 21 December 2010

© The American College of Gastroenterology 2011. All Rights Reserved.
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