Delayed H pylori treatment after ulcer diagnosis is strongly linked to worse outcomes

  • Gastrointest Endosc

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • After peptic ulcer diagnosis, waiting >1 week to begin Helicobacter pylori eradication therapy may raise risk for recurrent and complicated ulcer and gastric cancer.

Why this matters

  • Delays in H pylori eradication are common, but consequences are unclear.

Key results

  • 7629 patients developed recurrent ulcer, 2050 complicated ulcer, and 50 gastric cancer.
  • Recurrent ulcer risks with treatment delays vs within 7 days:
    • 8-30 days: HR, 1.17;
    • >365 days: HR, 3.55.
  • Complicated ulcer risks with treatment delays vs within 7 days:
    • 8-30 days: HR, 1.55;
    • >365 days: HR, 6.14.
  • Gastric cancer risk with treatment delays vs within 7 days:
    • 61-365 days: HR, 3.64;
    • >365 days: HR, 4.71.
  • For all trends: P<.001.>
  • Researchers calculated that 23% of recurrent ulcers, 33% of complicated ulcers, and 30% of gastric cancers could be prevented with H pylori treatment within 1 month of ulcer diagnosis.

Study design

  • Population-based nationwide Swedish cohort study, adults treated for H pylori after peptic ulcer diagnosis (n=29,032).
  • Using registry data, researchers compared outcomes to time elapsed between ulcer diagnosis and H pylori treatment.
  • Follow-up: 75 months.
  • Outcomes: recurrent ulcer, complicated ulcer, gastric cancer.
  • Funding: Swedish nonprofit organizations; Karolinska Institutet.

Limitations

  • Data on smoking, alcohol consumption not available.
  • Causality not established.