Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 28, 2011; 17(40): 4509-4516
Published online Oct 28, 2011. doi: 10.3748/wjg.v17.i40.4509
Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption
Francesco Manguso, Elisabetta Riccio, Germana de Nucci, Maria Luisa Aiezza, Gerardino Amato, Linda Degl’Innocenti, Maria Maddalena Piccirillo, Gianfranco De Dominicis, Tara Santoro, Elena Trimarco, Antonio Balzano
Francesco Manguso, Elisabetta Riccio, Germana de Nucci, Tara Santoro, Antonio Balzano, Complex Operating Unit of Gastroenterology, AORN A Cardarelli, 80131 Napoli, Italy
Maria Luisa Aiezza, Elena Trimarco, Complex Operating Unit of Pharmacy, AORN A Cardarelli, 80131 Napoli, Italy
Gerardino Amato, Linda Degl’Innocenti, Maria Maddalena Piccirillo, Complex Operating Unit of Microbiology, AORN A Cardarelli, 80131 Napoli, Italy
Gianfranco De Dominicis, Complex Operating Unit of Pathology, AORN A Cardarelli, 80131 Napoli, Italy
Author contributions: Manguso F, Riccio E and Balzano A conceived the study and wrote the article; de Nucci G and Santoro T collected data and reviewed the final version; Aiezza ML and Trimarco E determined the pharmacological history, collected data, and reviewed the final version; Amato G, Degl’Innocenti L, and Piccirillo MM performed the serological and microbiological tests, and reviewed the final version; De Dominicis G performed the histological evaluation and reviewed the final version.
Correspondence to: Dr. Francesco Manguso, Complex Operating Unit of Gastroenterology, AORN A Cardarelli, Via A Cardarelli 9, 80131 Napoli, Italy. manguso@alice.it
Telephone: +39-81-7474034 Fax: +39-81-7473018
Received: January 27, 2011
Revised: June 9, 2011
Accepted: June 16, 2011
Published online: October 28, 2011
Abstract

AIM: To establish the prevalence of Helicobacter pylori (H. pylori) infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs (NSAIDs).

METHODS: A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease (CLO) test, histological examination, and bacterial culture. IgG anti-CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections.

RESULTS: Eighty patients, 61 males (76.3%), mean age 61.2 ± 15.9 years, were consecutively enrolled. Forty-seven (58.8%) patients occasionally consumed NSAIDs, while 33 (41.3%) were on chronic treatment with low-dose aspirin (LD ASA). Forty-four (55.0%) patients were considered infected by H. pylori. The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The highest accuracy (92.5%) was obtained with the culture of biopsy specimens.

CONCLUSION: Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

Keywords: Helicobacter pylori; Helicobacter pylori infection; Low-dose aspirin; Non-steroidal antiinflammatory drugs; Peptic ulcer hemorrhage; Endoscopy