Effect of helicobacter pylori eradication therapy on risk of hospitalization for a major ulcer event

[[abstract]]Study Objective. To compare Helicobacter pylori eradication therapy with antisecretory therapy alone on the risk of hospitalization for a major ulcer event. Design. Retrospective, population-based cohort study. Data Source. The 2000-2006 National Health Insurance database in Taiwan. Patients. A total of 838,176 patients diagnosed with a gastrointestinal ulcer and who filled at least one prescription for antiulcer therapy either H. pylori eradication therapy (331,364 patients [39.53%]) or antisecretory therapy alone (506,812 patients [60.47%]), between January 1, 2001, and December 31, 2006. Measurements and Main Results. The primary outcome was hospitalization for a major ulcer event, defined as a gastrointestinal ulcer with hemorrhage and/or perforation. Cox proportional hazards models, adjusted for demographic and clinical characteristics, were used to compare the risk of hospitalization for a major ulcer event between the group receiving H. pylon eradication therapy (triple or quadruple combination therapy that includes an antisecretory agent) and the group receiving antisecretory therapy alone (histamine(2)-receptor blocker or proton pump inhibitor). The H. pylon eradication therapy group was divided into initial users (combination therapy received immediately after gastrointestinal ulcer diagnosis) and late users (combination therapy received after antisecretory therapy with time lag 365 days from ulcer diagnosis). A secondary analysis was conducted in the three late H. pylon eradication therapy subgroups to determine if risk of hospitalization for major ulcer events differed by timing of receipt of therapy. Compared with the antisecretory therapy alone group, the H. pylon therapy group (initial users) had a significantly decreased risk of hospitalization for major ulcer events (adjusted hazard ratio [AHR] 0.57, 95% confidence interval [CI] 0.54-0.59, p 365 days, AHR 1.74, 95% CI 1.67-1.80, p < 0.001) compared with those who received H. pylori therapy within 6 months (<= 180 days) after gastrointestinal ulcers were diagnosed. Conclusion. Helicobacter pylori therapy given within 6 months of a diagnosis of gastrointestinal ulcer was associated with a reduced risk of hospitalization for major ulcer events. Our findings extend the evidence from clinical trials that report the value of H. pylori eradication therapy in reducing ulcer recurrence by documenting the real-world benefit of reducing the risk of hospitalization for major gastrointestinal ulcer events