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Helicobacter pylori and proton pump inhibitor therapy: One diagnostic method is enough?

Published:November 04, 2017DOI:https://doi.org/10.1016/j.ejim.2017.10.023
      In a recent study Negovan et al. assessed the impact of pathological and clinical predisposing factors (histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pyloriH. pylori infection) on severe gastro-duodenal lesions in patients on long-term low-dose aspirin and proton pump inhibitors (PPI) treatment [
      • Negovan A.
      • Iancu M.
      • Moldovan V.
      • et al.
      The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy.
      ]. They enrolled patients with chronic low-dose aspirin and PPI therapy referred for an upper digestive endoscopy between September 2012 and December 2015. Patients attended esophagogastroduodenoscopy for the following reasons: digestive symptoms, anaemia or screening for gastrointestinal bleeding risk (before the initiation of combined antithrombotic therapy, before major surgery). Patients with gastro-duodenal surgery, varices, active severe bleeding or patients in whom a gastric cancer was discovered were excluded. The authors also excluded patients with haematological disorders (leukaemia, lymphoma, aplastic or haemolytic anaemia), as well as patients with severe medical conditions (cancer, cardiac, respiratory, liver or kidney end-stage disease), autoimmune gastritis, dysplasia. Two biopsy specimens from the antrum and two from the corpus were taken for routine histology and were examined by a single pathologist. The observed relative frequency of severe gastro-duodenal lesions was 27.4%. There were no significant differences between cases (modified Lanza score ≥ 3) and controls regarding H. pylori status (21/65 cases vs. 52/172 controls, p = 0.875). In the univariate logistic regression model, factors associated with severe gastro-duodenal lesions were gender (OR = 1.87, 95% CI: 1.04–3.41), assumption of anticoagulants (OR = 2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR = 1.85, 95% CI: 1.04–3.32), congestive heart failure (OR = 2.59, 95% CI: 1.16–6.62), anaemia (OR = 3.01, 95% CI: 1.67–5.47) and smoking (OR = 4.29, 95% CI: 1.57–12.32). Anticoagulants (p = 0.04) and anaemia (p = 0.02) were risk factors for severe lesions via multivariate regression analysis.

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