A team from The Chinese University of Hong Kong, China, investigated the incidence of non-H. pylori, non-NSAID ulcers presenting with gastrointestinal (GI) bleeding.
1675 consecutive patients presenting with upper GI bleeding over a period of 12 months were enrolled into the prospective study.
Upper endoscopy was performed, with biopsy specimens taken from the antrum and body of the stomach for a biopsy urease test (BUT) and histology for detection of H. pylori.
Exposure to non-steroidal anti-inflammatory drugs (NSAID) or aspirin within 4 weeks of hospitalization was carefully scrutinized. A 6-week course of treatment with an H2-receptor antagonist was prescribed for patients who did not use an NSAID and had a negative BUT result.
Follow-up endoscopy was performed to confirm H. pylori, status with a BUT and histology.
|4% of ulcer bleeders had |
non-H. pylori, non-NSAID ulcers.
Positive histology at either initial or follow-up endoscopy was used as the standard for diagnosing H. pylori, infection.
Among 977 patients who were found to have ulcer bleeding, 44% had exposure to aspirin or an NSAID.
Of the 543 non-NSAID users, 79% had a positive BUT and 21% were BUT negative on initial endoscopy.
89 out of 112 patients who were NSAID-negative and BUT-negative returned for follow-up endoscopy. 55% of these were then found to have a positive BUT and positive histology.
The researchers found that only 4% of the 977 patients admitted with ulcer bleeding were confirmed to have non-H. pylori, non-NSAID ulcers.
Dr Henry Lik-Yuen Chan concluded on behalf of the team, "Non-H. pylori, non-NSAID bleeding ulcer is uncommon. A negative BUT is unreliable for exclusion of H. pylori infection during the acute phase of ulcer bleeding."