Time latencies of Helicobacter pylori eradication after peptic ulcer and risk of recurrent ulcer, ulcer adverse events, and gastric cancer: a population-based cohort study

被引:23
作者
Sverden, Emma [1 ,3 ]
Brusselaers, Nele [1 ,2 ]
Wahlin, Karl [1 ]
Lagergren, Jesper [1 ,4 ,5 ]
机构
[1] Karolinska Inst, Karolinska Univ Hosp, Dept Mol Med & Surg, Upper Gastrointestinal Surg, Stockholm, Sweden
[2] Karolinska Inst, Karolinska Univ Hosp, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden
[3] Soder Sjukhuset, Dept Upper Gastrointestinal Surg, Stockholm, Sweden
[4] Kings Coll London, Div Canc Studies, London, England
[5] Guys & St Thomas NHS Fdn Trust, London, England
基金
瑞典研究理事会;
关键词
METAANALYSIS; INFECTION;
D O I
10.1016/j.gie.2017.11.035
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
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页码:242 / +
页数:10
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