Predictors of In-Hospital Mortality in Helicobacter pylori-Negative, Non-Variceal Upper Gastrointestinal Bleeding: A...

With the global decline in Helicobacter pylori infection, upper gastrointestinal bleeding (UGIB) is increasingly driven by non-infectious, non-Nonsteroidal Anti-Inflammatory Drug (NSAID) mechanisms, particularly antithrombotic use and comorbidity-related mucosal injury. This study aimed to characterize the etiology, clinical profile, and in-hospital mortality predictors in patients with H. pylori-negative, non-variceal UGIB in a Colombian tertiary care setting.

We conducted a retrospective cohort study at a quaternary hospital in Barranquilla, Colombia, including all adults (≥18 years) hospitalized with endoscopically confirmed non-variceal UGIB and negative H. pylori testing (rapid urease test and/or histology). Clinical, endoscopic, and medication data were analyzed.

Of 285 patients, the median age was 60 years (IQR: 39-73), and 54% were male. NSAID use was rare (2.8%), whereas antithrombotic exposure was prevalent (28.8%), including low-dose aspirin (18.2%) and dual antiplatelet therapy (4.9%). The most common endoscopic findings were erosive gastropathy (45%) and ulcers (12%). Overall in-hospital mortality was 5% (n=13). In multivariable analysis, age >60 years (aOR: 2.9; 95% CI: 1.7-10.2; p = 0.05), cardiovascular complications (aOR: 7.8; 95% CI: 1.9-32.0; p = 0.004), encephalopathy (aOR: 8.5; 95% CI: 2.2-33.0; p = 0.009), and antiplatelet plus anticoagulant therapy (aOR: 5.3; 95% CI: 1.6-17.5; p = 0.006) were independently associated with in-hospital mortality.

In this cohort, in-hospital mortality in non-variceal UGIB patients without H. pylori infection was associated with systemic factors such as advanced age, cardiovascular complications, encephalopathy, and antiplatelet-anticoagulant combination therapy rather than bleeding lesions. These findings support risk stratification based on comorbidities and medication use in this growing population.