Blödende peptisk ulcus. Helicobacter pylori -praevalens og forbrug af non-steroide antiinflammatoriske stoffer/acetylsalicylsyre
Sammanfattning
Introduction:Helicobacter pylori (HP) infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs)/acetyl salicylic acid (ASA) are risk factors for bleeding peptic ulcer. HP eradication reduces the risk of rebleeding. Antibiotics, proton pump inhibitors (PPI) and presence of blood in the stomach can affect the HP test. The objectives of this study were to determine the HP prevalence and NSAID/ASA use in patients with bleeding ulcer in a low-prevalence HP area, to determine the proportion of idiopathic ulcers and to estimate the proportion of initially false negative HP tests . In addition, the objective was to describe changes in the characteristics of the patients who were admitted with ulcer bleeding during the last two decades. Methods: Retrospective review of the records of patients who were admitted with a bleeding ulcer in 2003 to 2006 at The Department of Medical Gastroenterology S, Odense University Hospital. Patients with initially negative or missing HP tests were offered a urea breath test. This population was compared with prospective registrations for the periods 1990-1992 and 2000. Results: A total of 264 patients were admitted in 2003-2006. The mean age was 72 years. The HP-prevalence was 34%, and 81% had used NSAID/ASA, as compared with 55% in 1990-1992. The proportion of idiopathic peptic ulcer disease was 6.6%. At admission, 19% and 17% of the patients were in treatment with PPI and antibiotics, respectively. Thirteen percent of the initially HP-negative patients were later found to be HP-positive. Conclusion: Compared to previous studies, we found a lower HP prevalence (34%) and a higher proportion of NSAID/ASA usage (81%) in 2003-2006. As we found 13% false negative HP-tests when factors that may affect the HP test were present, we advise that a retest be made where these factors are present and the initial HP test is negative.