HasH. pyloriPrevalence in Bleeding Peptic Ulcer Been Underestimated? A Meta-Regression

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OBJECTIVES:It has been suggested that prevalence ofHelicobacter pylori(Hp) in peptic ulcer bleeding (PUB) is lower than that in non-complicated ulcers. AsHpinfection is elusive in PUB, we hypothesized that this low prevalence could be related to an insufficiently intensive search for the bacteria. The aim of the study was to evaluate whether the prevalence ofHpin PUB depends on the diagnostic methods used in a given study.METHODS:A systematic review was performed of studies assessing the prevalence ofHpinfection in patients with PUB. Data were extracted in duplicate. Univariate and multivariate random-effects meta-regression analyses were performed to determine the factors that explained the differences inHpprevalence between studies.RESULTS:The review retrieved 71 articles, including 8,496 patients. The mean prevalence ofHpinfection in PUB was 72%. The meta-regression analysis showed that the most significant variables associated with a high prevalence ofHpinfection were the use of a diagnostic test delayed until at least 4 weeks after the PUB episode—odds ratio: 2.08, 95% confidence interval: 1.10–3.93,P=0.024—and a lower mean age of patients—odds ratio: 0.95 per additional year, 95% confidence interval: 0.92–0.99,P=0.008.CONCLUSIONS:Studies that performed a delayed test and those including younger patients found a higher prevalence ofHp, approaching that recorded in cases of non-bleeding ulcers. These results suggest that the low prevalence ofHpinfection described in PUB may be related to the methodology of the studies and to patients' characteristics, and that the true prevalence ofHpin PUB is still to be determined. Our data also support the recent recommendations of the International Consensus on Non-Variceal Upper Gastrointestinal Bleeding regarding the performance of a delayed diagnostic test whenHptests carried out during the acute PUB episode are negative.

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