Has H. pylori Prevalence in Bleeding Peptic Ulcer Been Underestimated? A Meta-Regression

Abstract

Studies that performed a delayed test and those including younger patients found a higher prevalence of Hp, approaching that recorded in cases of non-bleeding ulcers. These results suggest that the low prevalence of Hp infection described in PUB may be related to the methodology of the studies and to patients' characteristics, and that the true prevalence of Hp in PUB is still to be determined. Our data also support the recent recommendations of the International Consensus on Non-Variceal Upper Gastrointestinal Bleeding regarding the performance of a delayed diagnostic test when Hp tests carried out during the acute PUB episode are negative.

Accuracy of Urea Breath Test Performed Immediately After Emergency Endoscopy in Peptic Ulcer Bleeding

“…The presence of blood in the stomach, which is a limiting factor for invasive tests [34,42], does not seem to affect UBT accuracy either, as some authors say [43]. Unlike other studies [8], we did not find that age made any impact in UBT accuracy. Gender, ulcer location, or NSAID therapy also did not modify the results, as it has been previously reported [8,27].…”

“…This prevalence is somewhat higher than 70-72% obtained in two meta-analyses in a bleeding population [7,8] although similar to that obtained from some studies included in these meta-analyses (32-100%) and also very similar to that published in our country by some experts [8,27]. If we include for prevalence determination the 17 patients with no delayed UBT but who had an invasive test performed at endoscopy, prevalence drops to 77.4%; this fact could be explained by the high rate of false-negatives for invasive tests in the setting of a bleeding patient [7].…”

“…Another regressive meta-analysis including 8,496 patients has shown that the most significant variable associated with a high prevalence of Hp infection in PUB is the use of a delayed diagnostic test [8]; however, accuracy of every single type of test was not evaluated and only [8].…”

“…Two large meta-analyses have evaluated the different methods for Hp detection in peptic ulcer bleeding (PUB) patients [7,8]; however, clinical trials in this field have been scarce in the last years and the associations found by meta-regressions are observational, and weaker than derived from randomized comparisons [9].…”

“…The accuracy of the urea breath test (UBT) in PUB patients has not been widely evaluated taking into account its performance at the moment of the hemorrhage and once the episode has resolved (delayed test); moreover, a group of experts have recently pointed out the importance of addressing this issue [8].…”