Delayed H. pylori eradication retreatment ups subsequent upper GI bleeding risk

Patients who have failed initial Helicobacter pylori eradication therapy are at heightened risk of upper gastrointestinal bleeding (UGIB), with the risk increasing progressively with longer time until retreatment, according to a recent study.

Researchers reviewed the medical records of 70,518 patients (median age, 54 years; 46.3 percent male) with H. pylori infection in Hong Kong who had received their first course of clarithromycin-based triple therapy, among whom 8,330 (11.8 percent) required retreatment after failed initial therapy. The median follow-up duration was 7.65 years.

Of the patients who failed initial therapy, 1,173 (1.7 percent), 2,162 (3.1 percent) and 4,995 (7.1 percent) received retreatment with a delay of ≤3, 3–12 and >12 months, respectively. Majority of the patients (85.6 percent) underwent one course of retreatment only.

Cox proportional hazard analysis revealed that patients who did vs did not require retreatment had an overall higher risk of UGIB, even after receipt of last eradication therapy (adjusted hazard ratio [HR], 1.50, 95 percent confidence interval [CI], 1.34–1.69).

Moreover, the risk of UGIB increased progressively with longer time between initial and final eradication therapies. A delay in retreatment of <3, 3–12 and >12 months increased the risk by 16 percent (HR, 1.16, 95 percent CI, 0.88–1.54), 35 percent (HR, 1.35, 95 percent CI, 1.07–1.69) and 68 percent (HR, 1.68, 95 percent CI, 1.46–1.94), respectively (p=0.038).

In light of the findings, the researchers emphasized the importance of administering early retreatment, within 3 months preferably, in order to minimize subsequent UGIB risk.