Low seroprevalence of Helicobacter pylori infection in patients with stress ulcer bleeding - a prospective evaluation of patients on a cardiosurgicalintensive care unit

Objective: The pathogenesis of stress ulceration in seriously ill patients is uncertain and the pathogenic role of Helicobacter pylori infection is un known. We therefore assessed the seroprevalence of patients of a cardiosurg ical intensive care unit (ICU) with clinically important stress ulcer bleed ing. We compared this prevalence with a control group matched for this kind of surgical intervention, missing history of peptic ulcer disease, age and gender. Design: Prospective survey Setting: Cardiosurgical ICU in a university teaching hospital. Patients and participants: Two thousand five hundred seventy cardiosurgical patients with intravenous ranitidine stress ulcer prophylaxis were screene d for clinically important stress ulcer bleeding. Helicobacter pylori serop ositivity was measured in all patients with a clinically important bleeding and in a control group of 245 consecutive cardiosurgical patients, matched for the kind of cardiosurgical intervention, age and gender. Results: In 56 of 2570 (2.1 %) patients signs of clinically important bleed ing were seen. Endoscopical examination revealed stress ulcer bleeding in 4 2 cases. The incidence of stress ulcer bleeding was 1.6 %. The seropositivi ty of the group with ulcer bleeding was 45.2 % whereas 62.4 % of the patien ts in the control group were Helicobacter pylori positive (p = 0.08), Conclusions: Our results suggest that the Helicobacter pylori infection doe s not play a pathogenic role in stress ulcer breeding. Prophylactic cure of Helicobacter pylori can not be recommended in this setting.