Incidence of Helicobacter pylori in operatively managed acute nonvariceal upper gastrointestinal bleeding

Abstract

Helicobacter pylori is a known contributor to ulcerogenesis and nonvariceal acute upper gastrointestinal hemorrhage. Its incidence in operatively managed patients with upper gastrointestinal hemorrhage is ill defined. Patients undergoing surgery for upper gastrointestinal hemorrhage secondary to gastroduodenal ulceration between 1993 and 1998 at the University of Tennessee were retrospectively reviewed. Factors examined included age, nonsteroidal drug use, endoscopic intervention, urgency of operation, and H. pylori status confirmed by histologic examination. Forty-two patients had surgery with three excluded because of a lack of histologic evaluation. The site of bleeding was gastric in 23 and duodenal in 14. H. pylori infection was present in nine (39.1%) gastric and 11 (68.7%) duodenal ulcers. The incidence of H. pylori infection was reduced in those over 60 years of age (28.6%). Endoscopy was performed in all patients, but only two had biopsies for assessment of H. pylori. Operative morbidity was 17.9% and mortality was 5.1%. No patient had rebleeding following surgery. The incidence of H. pylori in this population is less than that reported in uncomplicated ulcer disease. Those older than 60 tended to be H. pylori negative. Endoscopic assessment for H. pylori was infrequent. Traditional indications for surgical intervention in ulcer hemorrhage should not be altered based on H. pylori status.