Heavy bacterial loads of H-pylori may precipitate duodenal ulcer bleeding but not bleeding severity

BACKGROUND/AIMS: To determine whether severity of Helicobacter pylori (H. p ylori) infection is aggravated during acute duodenal ulcer bleeding and rel ated to bleeding severity. METHODOLOGY: One hundred and thirty-eight patients with H. pylori-infected bleeding duodenal ulcer and 112 non-bleeding cases were included in the stu dy. A comparison was made of the anti-H. pylori IgG titer, endoscopic findi ng, density of H. pylori (range: 1-5) in the antrum, and severity of antral gastritis (score: 0-3) between bleeding and non-bleeding cases. The role o f H. pylori in bleeding cases was further analyzed to survey its relationsh ip to the severity of bleeding judged by clinical parameters. The H. pylori status of patients with rebleeding within the first week was compared to t hat of the non-rebleeding cases as well. RESULTS: The anti-H. pylori IgG titer and H. pylori density of the non-blee ding group were lower than those of the bleeding group (0.466+/-0.288 vs. 0 .912+/-0.559, p<0.001; 2.13+/-1.02 vs. 3.34+/-1.32, p<0.001). The percentag es of bleeding ulcers in the study cases increased in a trend as the densit y of H. pylori increased (density: 1-5; 32.7%, 33.8%, 57.4%, 81.3%, 91.4%, p<0.001). Although the severity of gastritis and density of H. pylori discl osed an upward trend as bleeding severity increased, only ulcer size was si gnificantly associated with bleeding severity (p<0.05). The 10 cases with r ecurrent bleeding had higher bacterial density and serological titer than t he 128 non-rebleeding cases (p<0.005). CONCLUSIONS: Heavy bacterial loads of H. pylori infection may precipitate b leeding episodes of duodenal ulcer. However, in bleeding duodenal ulcer, th e status of H. pylori infection is not strongly associated with initial ble eding severity before therapeutic endoscopy. With the aim of enhancing hemo stasis and preventing rebleeding, further studies could focus on diminishin g the bacterial load of H. pylori during bleeding episodes.