Background and Aims

Helicobacter pylori is associated with peptic ulcer disease and gastric cancer. Therefore we wanted to test how various lengths of delays in H pylori eradication therapy influence the risk of recurrent peptic ulcer, ulcer adverse events, and gastric cancer.

Methods

This population-based nationwide Swedish cohort study included 29,032 patients receiving H pylori eradication therapy after peptic ulcer disease in 2005 to 2013. Predefined time intervals between date of peptic ulcer diagnosis and date of eradication therapy were analyzed in relation to study outcomes. Cox regression provided hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusted for age, sex, comorbidity, history of ulcer disease, use of ulcerogenic drugs, and use of proton pump inhibitors (PPIs).

Results

Compared with eradication therapy within 7 days of peptic ulcer diagnosis, eradication therapy within 8 to 30, 31 to 60, 61 to 365, and >365 days corresponded with HRs of recurrent ulcer of 1.17 (95% CI, 1.08-1.25), 2.37 (95% CI, 2.16-2.59), 2.96 (95% CI, 2.76-3.16), and 3.55 (95% CI, 3.33-3.79), respectively. The corresponding HRs for complicated ulcer were 1.55 (95% CI, 1.35-1.78), 3.19 (95% CI, 2.69-3.78), 4.00 (95% CI, 3.51-4.55), and 6.14, (95% CI, 5.47-6.89), respectively. For gastric cancer the corresponding HRs were .85 (95% CI, .32-2.23), 1.31 (95% CI, .31-5.54), 3.64 (95% CI, 1.55-8.56), and 4.71 (95% CI, 2.36-9.38), respectively.

Conclusions

Delays in H pylori eradication therapy after peptic ulcer diagnosis time-dependently increase the risk of recurrent ulcer, even more so for complicated ulcer, starting from delays of 8 to 30 days.

中文翻译：

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一项基于人群的队列研究：消化性溃疡后根除幽门螺杆菌的时间延迟以及复发性溃疡，溃疡不良事件和胃癌的风险

背景和目标

幽门螺杆菌与消化性溃疡疾病和胃癌有关。因此，我们想测试根除幽门螺杆菌的各种延迟时间如何影响复发性消化性溃疡，溃疡不良事件和胃癌的风险。

方法

这项基于人群的全国性瑞典队列研究包括2005年至2013年接受消化道溃疡病治疗后接受H幽门螺杆菌根除治疗的29,032名患者。分析了消化性溃疡诊断日期与根除治疗日期之间的预定时间间隔，并与研究结果进行了比较。Cox回归提供了危险比（HR）和95％置信区间（95％CI），并根据年龄，性别，合并症，溃疡病史，使用促溃疡药和使用质子泵抑制剂（PPI）进行了调整。

结果

与在消化性溃疡诊断后7天内根除治疗相比，在8至30、31至60、61至365和> 365天之内根除治疗对应于复发性溃疡的HR为1.17（95％CI，1.08-1.25），2.37 （95％CI，2.16-2.59），2.96（95％CI，2.76-3.16）和3.55（95％CI，3.33-3.79）。复杂性溃疡的相应HR为1.55（95％CI，1.35-1.78），3.19（95％CI，2.69-3.78），4.00（95％CI，3.51-4.55）和6.14，（95％CI，5.47- 6.89）。对于胃癌，相应的HR为0.85（95％CI，.32-2.23），1.31（95％CI，.31-5.54），3.64（95％CI，1.55-8.56）和4.71（95％CI， 2.36-9.38）。

结论

延误幽门螺杆菌根除治疗后消化性溃疡诊断时间依赖性增加复发性溃疡的风险，更是让复杂性溃疡，从8到30天的延迟开始。