Absence ofHelicobacter pyloriis not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

Yeong Yeh Lee,Jayaram Menon,Syed Abdul Aziz Syed Hassan,Nordin Noridah

doi:10.7717/peerj.257

Yeong Yeh Lee, Jayaram Menon + Show 2 more

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https://doi.org/10.7717/peerj.257

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Abstract

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.

Highlights

Non-variceal upper gastrointestinal (GI) bleeding remains a prevalent condition and its mortality hardly change despite a declining trend of peptic ulcer disease and improvement in therapeutic approaches
There is a reducing trend of peptic ulcer disease observed within Asia, and this is largely a result of reducing prevalence of H. pylori infection
The population in the north-eastern region of Peninsular Malaysia, that consists of 90% ethnic Malays, had a seroprevalence of Helicobacter pylori (H. pylori) infection of only 4.2% among 496 blood donors and 4.8% among 921 patients attending a health screening clinic (Uyub et al, 1994)

Summary

Introduction

Non-variceal upper gastrointestinal (GI) bleeding remains a prevalent condition and its mortality hardly change despite a declining trend of peptic ulcer disease and improvement in therapeutic approaches. Reports from two tertiary hospitals in central Peninsular Malaysia indicated an overall low prevalence of non-variceal upper GI bleeding among the ethnic Malays (Lim et al, 2003; Lakhwani et al, 2000; Lee, Mahendra Raj & Graham, 2013). There is a reducing trend of peptic ulcer disease observed within Asia, and this is largely a result of reducing prevalence of H. pylori infection. The population in the north-eastern region of Peninsular Malaysia (state of Kelantan), that consists of 90% ethnic Malays, had a seroprevalence of Helicobacter pylori (H. pylori) infection of only 4.2% among 496 blood donors and 4.8% among 921 patients attending a health screening clinic (Uyub et al, 1994). The incidence of peptic ulcer perforations within the region from 1991 to 1992 was only 1.5/100,000 person-years (Uyub et al, 1994)

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