No significant association between H. pylori status and peptic ulcer bleeding recurrence among antithrombotic users: a preliminary study in a real-world population with high PPI use

Eradication of Helicobacter pylori ( H. pylori ) for prevention of peptic ulcer bleeding (PUB) recurrences is not well-established in antithrombotic users in current clinical practice. Retrospective, multicenter cohort study including consecutive patients after a first PUB between 2008 and 2023 in real-world clinical settings. Follow-up continued until first PUB recurrence, death, loss to follow-up, or review date. Recurrence incidence was analyzed by H. pylori status, and recurrence risk using Cox regression adjusted for age, sex, NSAID use, and long-term proton pump inhibitors (PPI) prescription. Among 1,675 patients, antithrombotics were prescribed in 525 (31%) and long-term PPI in 1,021 (61%) at discharge after first PUB. Antithrombotic users received long-term PPI in 429 (82%) cases. Following first PUB (and eventual treatment), 94 (5.6%) remained H. pylori -positive, 936 (56%) were negative, and 645 (38%) were untested. Incidence for first PUB recurrence was 7.2% for the whole cohort, 22% in H. pylori -positive, 7.7% in negatives, and 4.2% in untested. Adjusted recurrence risk was 3.7-fold higher (95% CI: 2.3–6.1) in H. pylori -positive vs. negative, and 4.7 times higher (95% CI: 2.6–8.7) in patients who remained positive vs.eradicated. Among antithrombotic users, first PUB recurrence incidence was 5.1% for the cohort, 7.1% in H. pylori -positive, 8% in negatives, and 2% in untested; and no adjusted risk differences were found. In real-word clinical practice, H. pylori infection increases the risk of recurrence after first PUB. In the subgroup of patients receiving antithrombotics with high long-term PPI use, recurrence incidence is low, and no statistically significant association between H. pylori status and PUB recurrence was observed.