What Is the Best Strategy for Diagnosis and Treatment of Helicobacter pylori in the Prevention of Recurrent Peptic Ulcer Bleeding? A Cost-Effectiveness Analysis

Abstract

In patients with bleeding peptic ulcer, empirical treatment of H. pylori infection immediately after feeding is restarted is the most cost-effective strategy for preventing recurrent hemorrhage.

Management ofHelicobacter pyloriinfection—the Maastricht IV/ Florence Consensus Report

“…On the other hand, delaying treatment to after discharge leads to reduced compliance or loss to follow-up without receiving treatment 163. Based on a decision analytic model, it has been recently proposed that empirical treatment of H pylori infection in patients with bleeding peptic ulcer, immediately after feeding is restarted, is the most cost-effective strategy for preventing recurrent haemorrhage 164. The most influential variable in this analysis was the prevalence of H pylori infection in patients with peptic ulcer bleeding.…”

Diagnosis, Treatment, and Outcome in Patients with Bleeding Peptic Ulcers andHelicobacter pyloriInfections

“…Eradication therapy is suggested for both duodenal and gastric ulcers in patients infected with Hp [13], regardless of whether they have complications. Although there is no direct causal relationship between Hp infection and early rebleeding in patients with peptic ulcer bleeding [80, 81], empirical Hp eradication as soon as patients resume eating is the most cost-effective strategy for preventing recurrent hemorrhage [82]. …”

Increasing Testing for Helicobacter pylori Infection to Improve Quality of Patient Care

“…Yet, despite the cumulative evidence and implorations of experts, so many patients who would benefit from an appropriate H pylori treatment approach with confirmation of cure do not receive it. Although few data (and some experts) support presumptive treatment in patients with bleeding ulcers, 10 this seems an acknowledgement of the frequency of imperfect care rather than an ideal solution. Instead, in patients with suspected H pylori infection that is proven with testing, best available evidence should be used to guide antimicrobial therapy followed by eradication confirmation.…”