Risk factors for presentation with bleeding in patients with Helicobacter pylori-related peptic ulcer diseases

At present, there is no study that simultaneously addresses the apparent di fferences between bacterial and host factors in patients with bleeding and nonbleeding Helicobacter pylori-related ulcer diseases. Therefore, we desig ned this prospective study to evaluate whether there are identifiable diffe rences between the two groups of patients whose H. pylori-related peptic ul cer diseases present with bleeding or dyspepsia. From July 1996 to November 1996, consecutive patients presenting with upper gastrointestinal bleeding or dyspepsia were enrolled if H. pylori-related ulcer diseases were confir med. Fifteen clinical, endoscopic, histologic, and serologic factors were t ested for association with ulcer bleeding by a logistic recession analysis. In the study period, bleeding occurred in 39 out of 119 patients with H. p ylori-related peptic ulcer diseases. Multivariate analysis showed that inge stion of nonsteroidal antiinflammatory drugs (NSAIDs; p = 0.0156; odds rati o = 5:4), ulcer size greater than or equal to 1 cm (p = 0.0033; odds ratio = 4:2), and low bacterial density (p = 0.0030; odds ratio = 4:1) were indep endent factors associated with the risk of bleeding. There were no associat ions between ulcer bleeding and age, sex, smoking, alcohol consumption, the histologic grade of gastritis, location and number of ulcers, and the cyto toxin-associated gene (CagA) status of H. pylori strain. Therefore, we conc luded that H. pylori-related ulcer patients who use NSAIDs or have large ul cers are more likely to present with upper,gastrointestinal bleeding; that the CagA-bearing strains are not associated with the development of bleedin g complication in patients with peptic ulcer diseases; and that the exact r eason concerning the association between low bacterial density and ulcer bl eeding merits further investigation.