Abstracts
2000 Digestive Disease Week

# 2334 Helicobacter Pylori in Operatively Managed Nonvariceal Acute Upper Gastrointestinal Bleeding.
Christopher S. Callicutt, Stephen W. Behrman, A. Osama Gaber, Memphis, TN

Helicobacter pylori (HP) is a known contributor to ulcerogenesis and nonvariceal acute upper gastrointestinal (GI) hemorrhage. Despite the improved identification and treatment of HP in the last 5 years, its incidence in operatively managed patients with upper GI hemorrhage is ill-defined. Methods: The records of all patients admitted and receiving operations for acute upper GI hemorrhage secondary to bleeding gastric or duodenal ulcers between January 1993 and December 1998 at the University of Tennessee affiliated hospitals were retrospectively reviewed. Indications for surgical intervention were exsanguinating hemorrhage, failed therapeutic endoscopy, or chronic ulcer disease with prior hemorrhage. Factors examined included age, ulcer location, endoscopic findings ± intervention, urgency of operation, and HP infection. Steiner stains were reported on all pathologic specimens. Results: Thirty-eight patients (30 male, 8 female), with an average age of 55.1 years, underwent operation. Thirty (78%) patients had a history of ulcer disease and eleven (29%) had a prior history of GI hemorrhage. Seventeen (45%) had a history of NSAID use prior to hemorrhage. The site of bleeding was gastric in 24 (63.2%) and duodenal in 14 (36.8%). HP infection was present in 9 (37.5%) of gastric and 11 (78.6%) of duodenal ulcers. Characteristics of HP positive and negative patients are listed below. Diagnostic EGD was performed on all patients. Therapeutic EGD (epinephrine injection and/or cautery) was performed in 25 (65.8%) patients. Of those 25 patients, 12 (48%) were HP positive and 13 (52%) were negative. Only 2 patients had endoscopic biopsies for HP. Of those requiring emergent operation (n=14), all received therapeutic intervention and 16 (62.5%) were HP positive. Of those receiving semi-urgent (n=17) or elective (n=7) operations, 47.1% and 60% of the patients were positive for HP respectively. Perioperative mortality was 2.6%. Conclusion: The incidence of HP infection in this patient population is much less than expected. Older patients (>60 years) with ulcer hemorrhage tended to be HP negative. Endoscopic assessment for HP was infrequently assessed. With rare exception, traditional indications for surgical intervention in ulcer hemorrhage should not be delayed or altered based on HP status.