Schilling D, Demel A, Nüsse T, Weidmann E, Riemann J F
Department of Internal Medicine C, Klinikum Ludwigshafen, Academic Medical Hospital of the University of Mainz, Ludwigshafen, Germany.
Endoscopy. 2003 May;35(5):393-6. doi: 10.1055/s-2003-38775.
Eradication of Helicobacter pylori infection can reduce the rebleeding rate of peptic ulcer bleeding in the long term. There are few data on the influence of H. pylori on the rebleeding rate in the acute phase of bleeding however. We therefore prospectively investigated the influence of H. pylori infection on the early rebleeding rate in patients who had undergone successful endoscopic hemostasis treatment for peptic ulcer bleeding.
Between January 1996 and November 2000 all patients with peptic ulcer bleeding were evaluated consecutively. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. Bleeding activity was assessed using the Forrest classification. After successful endoscopic hemostasis all patients received omeprazole 40 mg or pantoprazole 40 mg, intravenously, twice a day for 3 days. Rebleeding episodes were recorded over 21 days following primary hemostasis.
344 patients were enrolled into the study. The prevalence of H. pylori infection was 62.9 %. A total of 51 patients showed rebleeding (14.8 %), of whom 31 were H. pylori-positive (60 %). There was no statistically significant difference between the H. pylori-positive and -negative patients, however. The rebleeding rate did not differ between patients with H. pylori infection alone and patients also using nonsteroidal anti-inflammatory drugs. When stratifying patients according to activity of bleeding at index endoscopy, we were also unable to find any significant influence of H. pylori infection on the outcome of Forrest class I and IIa bleedings.
Based on our data, it can be concluded that H. pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis.
根除幽门螺杆菌感染可长期降低消化性溃疡出血的再出血率。然而，关于幽门螺杆菌对出血急性期再出血率影响的数据较少。因此，我们前瞻性地研究了幽门螺杆菌感染对接受消化性溃疡出血内镜止血治疗成功的患者早期再出血率的影响。
1996年1月至2000年11月期间，对所有消化性溃疡出血患者进行连续评估。在初次内镜检查时，采用组织学和快速尿素酶试验诊断幽门螺杆菌感染。使用Forrest分类法评估出血活动情况。内镜止血成功后，所有患者均接受奥美拉唑40mg或泮托拉唑40mg静脉注射，每日2次，共3天。记录初次止血后21天内的再出血事件。
344例患者纳入研究。幽门螺杆菌感染率为62.9%。共有51例患者出现再出血（14.8%），其中31例幽门螺杆菌阳性（60%）。然而，幽门螺杆菌阳性和阴性患者之间无统计学显著差异。单纯幽门螺杆菌感染患者与同时使用非甾体抗炎药的患者再出血率无差异。根据初次内镜检查时的出血活动情况对患者进行分层时，我们也未发现幽门螺杆菌感染对Forrest I级和IIa级出血结局有任何显著影响。
根据我们的数据，可以得出结论，幽门螺杆菌感染不影响消化性溃疡出血患者内镜止血成功后的早期再出血率。
