Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

Aim. Helicobacter pylori (H. pylori) infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI) bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years). In-hospital mortality (3.6%), recurrent bleeding (9.6%) and need for surgery (4.0%) were uncommon in this population with a largely low risk score (85.2% with score ≤5). Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01) especially in the presence of duodenal ulcers (P = 0.04) despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

研究目的：幽门螺杆菌（Helicobacter pylori, H. pylori）感染在马来西亚半岛东北部人群中异常罕见，这为我们探究无幽门螺杆菌感染背景下的急性非静脉曲张性上消化道（gastrointestinal, GI）出血提供了契机。
研究方法：回顾性分析2003年至2006年期间胃肠道出血登记数据库中的全部病例，对经证实为非静脉曲张性病因的病例展开分析。以Rockall评分（Rockall score）＞5分为出血高危风险，本次研究的主要结局指标为住院病死率、再出血发生率及手术干预需求。
研究结果：非静脉曲张性上消化道出血的发病率为2.2/10万人年。消化性溃疡出血为最常见病因（1.8/10万人年）。该人群中住院病死率为3.6%、再出血发生率为9.6%、手术干预需求率为4.0%，且多数患者风险评分较低（85.2%的患者评分≤5分）。老年人群出血风险更高（平均年龄68.5岁，P=0.01），尽管胃溃疡更为常见，但合并十二指肠溃疡的患者出血风险尤为显著（P=0.04）。非甾体类抗炎药（non-steroidal anti-inflammatory drugs, NSAIDs）、阿司匹林及合并症为主要危险因素。
研究结论：在存在危险因素（尤其是老年人群使用致病药物）的情况下，无幽门螺杆菌感染可能并不会降低消化性溃疡出血的风险。