Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2015; 21(28): 8636-8643
Published online Jul 28, 2015. doi: 10.3748/wjg.v21.i28.8636
Clinical characteristics of Helicobacter pylori-negative drug-negative peptic ulcer bleeding
Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh
Woo Chul Chung, Eun Jung Jeon, Dae Bum Kim, Hea Jung Sung, Yeon-Ji Kim, Eun Sun Lim, Min-ah Kim, Jung Hwan Oh, Department of Internal Medicine, St. Paul’s Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Chung WC and Jeon EJ collected and analyzed the data, designed the research and wrote the manuscript; Kim DB, Sung HJ, Kim YJ, Lim ES, Kim M and Oh JW contributed to the paper’s conception and involved in editing the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Catholic University of Korea (PC14RISI0012).
Informed consent statement: Informed consent was not obtained because this study is a retrospective analysis of the clinical data collected after treatment course was completed. And the data of peptic ulcer bleeding were collected through computerized data analysis to target medical history. Therefore, this study does not affect the future treatment of patients. This study give rise to minimal risk to the patients. In this study, the patient’s clinical data collection and analysis, writing papers and papers from all over the research process, including the publication of a study were managed in secret for personal information (such as anonymized medical records). In addition, Institutional Review Board of the Catholic university of Korea, St. Paul’s hospital approved that this study has exemption from the informed consent.
Conflict-of-interest statement: The authors declare that they have nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at jwchulgi@gmail.com. Informed consent was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eun Jung Jeon, MD, Department of Internal Medicine, St. Paul’s Hospital, College of Medicine, the Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. jwchulgi@gmail.com
Telephone: +82-2-9582343 Fax: +82-2-9687250
Received: February 1, 2015
Peer-review started: February 2, 2015
First decision: March 10, 2015
Revised: March 30, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: July 28, 2015
Processing time: 178 Days and 15.5 Hours
Abstract

AIM: To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori (H. pylori)-negative and drug-negative] peptic ulcer bleeding (PUB).

METHODS: A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed. A total of 232 patients were enrolled in this study. The patients were divided into four groups according to the etiologies of PUB: idiopathic, H. pylori-associated, drug-induced and combined (H. pylori-associated and drug-induced) types. We compared the clinical characteristics and outcomes between the groups. When the silver stain or rapid urease tests were H. pylori-negative, we obtained an additional biopsy specimen by endoscopic re-examination and performed an H. pylori antibody test 6-8 wk after the initial endoscopic examination. For a diagnosis of idiopathic PUB, a negative result of an H. pylori antibody test was confirmed. In all cases, re-bleeding was confirmed by endoscopic examination. For the risk assessment, the Blatchford and the Rockall scores were calculated for all patients.

RESULTS: For PUB, the frequency of H. pylori infection was 59.5% (138/232), whereas the frequency of idiopathic cases was 8.6% (20/232). When idiopathic PUB was compared to H. pylori-associated PUB, the idiopathic PUB group showed a higher rate of re-bleeding after initial hemostasis during the hospital stay (30% vs 7.4%, P = 0.02). When idiopathic PUB was compared to drug-induced PUB, the patients in the idiopathic PUB group showed a higher rate of re-bleeding after initial hemostasis upon admission (30% vs 2.7%, P < 0.01). When drug-induced PUB was compared to H. pylori-associated PUB, the patients in the drug-induced PUB were older (68.49 ± 14.76 years vs 47.83 ± 15.15 years, P < 0.01) and showed a higher proportion of gastric ulcer (77% vs 49%, P < 0.01). However, the Blatchford and the Rockall scores were not significantly different between the two groups. Among the patients who experienced drug-induced PUB, no significant differences were found with respect to clinical characteristics, irrespective of H. pylori infection.

CONCLUSION: Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission. Therefore, these patients need to undergo close surveillance upon admission.

Keywords: Peptic ulcer; Gastrointestinal bleeding; Helicobacter pylori; Non-steroidal anti-inflammatory drug

Core tip: Recently, the number of Helicobacter pylori (H. pylori)-negative and drug-negative “idiopathic” peptic ulcers has increased. This study analyzed the clinical characteristics of idiopathic peptic ulcer bleeding (PUB) and compared different etiologies, including H. pylori infection and drug use. In conclusion, definite etiologic factors of PUB including drug and H. pylori infection seemed to play an insignificant role in the severity of PUB. Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission. Therefore, these patients need to undergo close surveillance upon admission.