Background &Aims: Helicobacter pylori-negative idiopathic ulcers are increasingly recognized. The secular trend and long-term outcome of this condition are unknown. Methods: We prospectively studied consecutive pa...Background &Aims: Helicobacter pylori-negative idiopathic ulcers are increasingly recognized. The secular trend and long-term outcome of this condition are unknown. Methods: We prospectively studied consecutive patientswith bleeding gastroduodenal ulcers from January to December 2000. The incidence and etiology of ulcers during this period were compared with that between September 1997 and August 1998. H pylori negative idiopathic ulcers were defined as negative tests for H pylori, no exposure to analgesics within 4 weeks, and absence of other risk factors for ulcers. After the ulcers had healed, patients with H pylori-negative idiopathic ulcers and patients with H pylori ulcers who received eradication therapy were followed up for 12 months without anti-ulcer drugs. Results: Six hundred thirty-eight patients had bleeding ulcers: 213 (33.4%) were H pylori ulcers, and 120 (18.8%) were H pylori negative idiopathic ulcers (vs 480 [50.3%] H pylori ulcers and 40 [4.2%] H pylori-negative idiopathic ulcers in 1997-1998; P <. 001). H pylori-negative idiopathic ulcers accounted for 16.1%of patients who were admitted for bleeding and 42.4%of patients who bled while in the hospital (P <. 0001); 28.3%of patients with H pylori-negative idiopathic ulcers had histologic evidence of past H pylori infection. The probability of recurrent ulcer complications in 12 months was 13.4%(95%CI: 7.3%-19.5%) in patients with H pylori-negative idiopathic ulcers and 2.5%(95%CI: 0.4%-4.6%) in patients with H pylori ulcers who received eradication therapy (P =. 0002). Conclusions: The incidence of H pylori-negative idiopathic bleeding ulcers is rising. These ulcers are prone to recurrent complications.展开更多
BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have ma...BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel.展开更多
文摘Background &Aims: Helicobacter pylori-negative idiopathic ulcers are increasingly recognized. The secular trend and long-term outcome of this condition are unknown. Methods: We prospectively studied consecutive patientswith bleeding gastroduodenal ulcers from January to December 2000. The incidence and etiology of ulcers during this period were compared with that between September 1997 and August 1998. H pylori negative idiopathic ulcers were defined as negative tests for H pylori, no exposure to analgesics within 4 weeks, and absence of other risk factors for ulcers. After the ulcers had healed, patients with H pylori-negative idiopathic ulcers and patients with H pylori ulcers who received eradication therapy were followed up for 12 months without anti-ulcer drugs. Results: Six hundred thirty-eight patients had bleeding ulcers: 213 (33.4%) were H pylori ulcers, and 120 (18.8%) were H pylori negative idiopathic ulcers (vs 480 [50.3%] H pylori ulcers and 40 [4.2%] H pylori-negative idiopathic ulcers in 1997-1998; P <. 001). H pylori-negative idiopathic ulcers accounted for 16.1%of patients who were admitted for bleeding and 42.4%of patients who bled while in the hospital (P <. 0001); 28.3%of patients with H pylori-negative idiopathic ulcers had histologic evidence of past H pylori infection. The probability of recurrent ulcer complications in 12 months was 13.4%(95%CI: 7.3%-19.5%) in patients with H pylori-negative idiopathic ulcers and 2.5%(95%CI: 0.4%-4.6%) in patients with H pylori ulcers who received eradication therapy (P =. 0002). Conclusions: The incidence of H pylori-negative idiopathic bleeding ulcers is rising. These ulcers are prone to recurrent complications.
文摘BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel.
