Incidence of complications of peptic ulcers in patients with Helicobacter pylori (Hp) infection and/or NSAID use in the era of Hp eradication

Abstract

Background: Hp and NSAID are considered as major pathogens in peptic ulcerations and their complications but little is known about the incidence of ulcers and their complications following wide-spread use of Hp eradication. The aims of the study were: 1) to analyze incidence of ulcers and their complications, bleeding and perforations at time when the Hp eradication has been used in ulcer therapy, and 2) to assess the impact of Hp infection and NSAID use on the incidence of ulcers and complications.

Material/methods: From 1996 to 2001, 381 patients with complications of peptic ulcers were admitted to the emergency surgery, including 273 patients with bleeding ulcers and 108 with perforations out of a sample of 6515 dyspeptic patients examined with upper endoscopy and 13C-urea breath test (UBT).

Results: The rate of ulcer bleeding and perforations, remained relatively constant throughout the study period. NSAID use in that group increased form 15.8% in 1999 to 19.4% in 2001. The incidence of Hp in patients with complications assessed by UBT or CLO was 76.7%, while the incidence of Hp in 7920 patients ranged form 72.8% in 1996 to 53.8% in 2001. There were 1940 (29.7%) patients with duodenal and/or gastric ulcer diagnosed by upper gastroscopy. The decline in the prevalence of peptic ulcer from about 44% to 8% occurred over the same time. A slight increase in the number of ulcer resulting from NSAID use was observed so was the number of ulcers without Hp or NSAID (idiopathic).

Conclusions: Despite decreased Hp prevalence, the incidence of ulcers complications remained unchanged probably due to increased use of NSAID and the appearance of idiopathic ulcers.