Helicobacter pylori mitigates upper gastrointestinal haemorrhage: trick or truth?

ABSTRACT

Upper gastrointestinal haemorrhage [UGIH] constitutes a serious health problem arising mainly from bleeding oesophageal varices [OV] or peptic ulcer disease [PUD] in Egypt.Conflicting results concerning antagonism or synergism between Helicobacter pylori [H.pylori] and UGIH deserves paramount interest .In the present case-control study 300 patients [150 bleeders and 150 non bleeders crossly-matched for age, sex, residence and endoscopic findings] were examined clinically, endoscopically and investigated for H. pylori infection in an essay to identify the relationship of H. pylori to UGIH. OV [37.3%] followed by duodenal ulcers [DU] [26%], gastric erosions [GE] [24.7%] and gastroesophageal reflux [GOR][12%] were the causes of UGIH which yielded positive connection to each of nonsteroidal antiinflammatory drugs [NSAIDs] [33/150=22%], chronic liver disease [CLD] [86/150=57%], and HCV [39/150 =26%] [P<0.05]. Strikingly H. pylori showed only an eminent inverse association with UGIH due to PUD [Z = 2.09] and NSAIDs consumption [P<0.05]. After controlling for confounders-logistic regression analysis presented H. pylori, NSAIDs and HCV as powerful effective independent factors with significant negative impact of H. pylori on UGIH [OR = 0.4, Cl = 0.4-0.86] and a positive one of NSAIDs [OR = 2.1, Cl = 1.2-3.4] and HCV [OR = 1.6, Cl = 1.1-4.0]. In conclusion our study confirmed the principal role of OV followed by PUD in causation of UGIH in addition to the increased risk of UGIH associated with NSAIDs, HCV and CLD. On the contrary H. pylori behaved as if a protective weapon against UGIH arising only from PUD [DU and GE]. No relation was found between H. pylori and UGIH from OV. In the meanwhile ulcer-like dyspepsia [ULD] and dysmotility like dyspepsia [DLD] might be a striking clinical presentation of H.pylori infection