Risk Factors Involved in Patients with Bleeding Peptic Ulcers – A Community Based Study

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Purpose: The aim of our study was to 1. Identify the specific risk factors involved in patients with peptic ulcer disease (PUD) and to determine if they predict bleeding in these patients. 2. Determine the frequency of association between non-steroidal anti-inflammatory drug (NSAID) use and Helicobacter pylori (H. pylori) infection in patients with PUD. 3. Determine if both rapid urease test and biopsy are necessary to test for H. pylori infection in patients with PUD. Methods: We conducted a community-based retrospective case control study. Data analysis occurred using a chi-square test of general association and logistic regression analysis. A total of 230 patients were included in the study between Jan 2004–June 2005 (128 PUD patients with evidence of bleeding served as cases, with a control group of 102 non-bleeding ulcer patients). H. pylori infection was assessed by using either rapid urease test or biopsy obtained from the gastric antrum, or both (in 81.7% of patients). Results: There were no statistically significant differences between the bleeding ulcer and control patient groups with respect to gender, age or location of ulcer. However, there was a significantly higher rate of NSAID use in the bleeding ulcer patient group (68.8% vs. 47.6%, P < 0.001; unadjusted odds ratio (OR) = 2.42; 95% CI = 1.42–4.51). The rate of H. pylori infection was lower in patients with bleeding ulcers (26.6% vs. 39.8%, P < 0.05; unadjusted OR = 0.58; 95% CI = 0.31–0.95). There was no interaction between NSAID use and H. pylori infection in predicting bleeding ulcer risk (P= .08). Sensitivity and specificity for urease test in detecting H. pylori was 75% and 99.7%, respectively, with a high positive predictive value of 93.8%. For patients with bleeding ulcers, the sensitivity of urease test was 53.8% versus 80.9% in controls, while specificity was 100% in the case group. Conclusion: NSAID's are associated with an increased risk of bleeding in PUD patients, although the rate of H. pylori infection was lower in patients with bleeding ulcers. Our study showed no significant association between these variables. In patients with a positive urease test, biopsy is not needed to confirm H. pylori infection which is cost-effective and treatment should be initiated for H. pylori. However, due to a high false negative rate, patients with negative urease test results should have biopsy done to confirm evidence of H. pylori infection.