Is non-Helicobacter pylori, non-NSAID peptic ulcer a common cause of upperGI bleeding? A prospective study of 977 patients

Background: Non-Helicobacter pylori, non-NSAID ulcer is relatively common i n Western countries. Whether it is a significant problem in the Orient is u nclear. The aim of this study was to investigate the incidence of non-H pyl ori, non-NSAID ulcers presenting with GI bleeding. Methods: A prospective study was done of 1675 consecutive patients presenti ng with upper GI bleeding over a period of 12 months. Upper endoscopy was p erformed with biopsy specimens taken from the antrum and body of the stomac h for a biopsy urease test (BUT) and histology for detection of H pylori, E xposure to nonsteroidal anti-inflammatory drugs (NSAID) or aspirin within 4 weeks of hospitalization was carefully scrutinized. A B-week course of tre atment with an H-2-receptor antagonist was prescribed for patients who did not use an NSAID and had a negative BUT result. Follow-up endoscopy was per formed to confirm H pylori status with a BUT and histology, Positive histol ogy at either initial or follow-up endoscopy was used as the standard for d iagnosing H pylori infection. Results: Among 977 patients who were found to have ulcer bleeding, 434 (44% ) had exposure to aspirin or an NSAID, Of the 543 non-NSAID users, 431 (79. 4%) had a positive BUT and 112 (20.6%) were BUT negative on initial endosco py. Eighty-nine of 112 patients who were NSAID negative, BUT negative retur ned for follow-up endoscopy. Forty-nine of 89 (55.1%) were found to have a positive BUT and positive histology at follow-up endoscopy, Only 40 of 977 (4.1%) patients admitted with ulcer bleeding were confirmed to have non-H p ylori, non-NSAID ulcers. Conclusions: Non-H pylori, non-NSAID bleeding ulcer is uncommon. A negative BUT is unreliable for exclusion of H pylori infection during the acute pha se of ulcer bleeding.