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Factors Associated With Adherence to Helicobacter pylori Testing During Hospitalization for Bleeding Peptic Ulcer
Kenneth W Hung1, Rita M Knotts2, Adam S Faye3
1Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York; Section of Digestive Diseases, Department of Medicine, Yale University, New Haven, Connecticut.
Insights
Testing hospitalized patients for Helicobacter pylori (H pylori) infection is crucial. Failure to test, especially in intensive care units (ICUs), increases rebleeding risk, highlighting the need for improved H pylori testing strategies.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Clinical Medicine
Background:
- Peptic ulcer disease (PUD) management guidelines emphasize Helicobacter pylori (H pylori) testing.
- Adherence to H pylori testing in hospitalized patients with bleeding ulcers requires investigation.
- The impact of H pylori testing on rebleeding risk in this population is not fully understood.
Purpose of the Study:
- To identify factors associated with H pylori testing adherence in hospitalized patients with bleeding ulcers.
- To evaluate the effect of H pylori testing on the risk of rebleeding or death.
Main Methods:
- Retrospective study of 830 inpatients undergoing endoscopy for bleeding gastric or duodenal ulcers (2011-2016).
- Electronic medical records were reviewed for H pylori detection methods (biopsy, serology, stool antigen).
- Multivariable models and Kaplan-Meier analysis assessed factors associated with testing and rebleeding risk.
Main Results:
- 19% of patients with bleeding ulcers were not tested for H pylori within 60 days of endoscopy.
- Intensive care unit (ICU) admission was strongly associated with nonadherence to H pylori testing (66% tested vs. 90% not in ICU).
- H pylori testing was linked to a 51% reduction in rebleeding or death risk within one year.
Conclusions:
- ICU admission is a significant barrier to H pylori testing in patients with bleeding ulcers.
- Failure to test for H pylori infection is independently associated with increased risk of rebleeding or death.
- Strategies are needed to enhance H pylori testing rates among hospitalized patients with bleeding ulcers.
Background & Aims:
Guidelines recommend testing patients with peptic ulcer disease for Helicobacter pylori infection. We sought to identify factors associated with adherence to testing for H pylori in patients hospitalized for bleeding ulcers and to evaluate whether performing these tests affect risk for rebleeding.
Methods:
We performed a retrospective study of 830 inpatients who underwent endoscopy from 2011 through 2016 for gastrointestinal bleeding from gastric or duodenal ulcers. We searched electronic medical records for evidence of tests to detect H pylori by biopsy, serologic, or stool antigen analyses. We used multivariable models to identify clinical, demographic, and endoscopic factors associated with testing for H pylori. Kaplan-Meier analysis was performed to determine whether H pylori testing altered risk for the composite outcome of rebleeding or death within 1 year of admission.
Results:
Among the patients hospitalized for bleeding peptic ulcer disease during the 6-year period, 19% were not tested for H pylori within 60 days of index endoscopy. Hospitalization in the intensive care unit (ICU) was the factor most frequently associated with nonadherence to H pylori testing guidelines (only 66% of patients in the ICU were tested vs 90% of patients not in the ICU; P < .01), even after we adjusted for ulcer severity, coagulation status, extent of blood loss, and additional factors (adjusted odds ratio, 0.42; 95% CI, 0.27-0.66). Testing for H pylori was associated with a 51% decreased risk of rebleeding or death during the year after admission (adjusted hazard ratio 0.49; 95% CI, 0.36-0.67).
Conclusions:
In an analysis of hospitalized patients who underwent endoscopy for gastrointestinal bleeding from gastric or duodenal ulcers, we found admission to the ICU to be associated with failure to test for H pylori infection. Failure to test for H pylori was independently associated with increased risk of rebleeding or death within 1 year of hospital admission. We need strategies to increase testing for H pylori among inpatients with bleeding ulcers.
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