Bleeding peptic ulcers: audit of eradication treatment for H pylori

Aims. To determine the outcomes after presentation with bleeding peptic ulc er and to assess the implementation of H pylori testing, treatment and foll ow-up testing. Methods. Case notes and endoscopy records of patients presenting to Aucklan d Hospital between 1993-95 were reviewed. Patients were recalled for interv iew and urea breath test. Results. Mean follow-up after presentation was three years. Eighty-nine pat ients were reviewed; 62% were confirmed as H pylori positive, although 20% had no biopsies. H pylori eradication treatment was given to 49 patients. T hirty-five patients had a definite treatment success; eight were failures ( eradication rate of 81%) and six received treatment without proof of H pylo ri by biopsy. Forty patients received acid suppression only. Twelve patient s had biopsy evidence of H pylori, and a further nine were proven H pylori positive at follow-up by urea breath test (initial tests had been negative or not performed). Nine patients had a rebleed; seven were confirmed H pylo ri positive either at presentation, or by follow-up breath test or endoscop ic biopsies. Conclusions. The incidence of H pylori in patients with bleeding peptic ulc er is underestimated and many infected patients do not receive eradication treatment. Rebleeding is largely preventable if more attention is given to diagnosis and treatment of H pylori and follow-up of treatment with a urea breath test.