Long‐term risk of upper gastrointestinal bleeding after Helicobacter pylori eradication: a population‐based cohort study

Summary Background The long‐term effects of H. pylori eradication in preventing upper GI bleeding (UGIB) remains unknown. Aim To determine the long‐term risks of UGIB after H. pylori eradication Methods We included all patients who had received clarithromycin‐containing triple therapy for the treatment of H. pyliori infection between 2003 and 2012, without subsequent need for re‐treatment. We included a propensity score (PS)‐matched endoscopy cohort of H. pylori ‐negative patients as controls. The primary endpoint was the risk of subsequent UGIB. A multivariable Cox model was used to compute the hazard ratio (HR) of UGIB. Results We included 62 738 H. pylori ‐eradicated and 62 738 PS‐matched H. pylori ‐negative patients, with a median follow‐up of 8.1 years (IQR 5.5‐10.6). The incidence of UGIB was 20.8 (95% CI 19.5‐22.1) and 13.6 (95% CI 12.7‐14.7) per 10 000 person‐years in H. pylori ‐eradicated and H. pylori ‐negative patients, respectively. Compared to controls, H. pylori ‐eradicated patients had a significantly higher risk of UGIB (HR: 1.65, 95% CI 1.49‐1.83). The risk of UGIB in H. pylori ‐eradicated patients increased after the first 2 years of follow up (HR: 2.18, 95% CI 1.91‐2.49). Age‐stratified analysis showed that patients >45 years had higher UGIB risk, even after eradication. Conclusions Despite H. pylori eradication, the long‐term risk of UGIB was still higher than in H. pylori ‐negative control subjects. The protective effects of eradication therapy in preventing UGIB appeared to be limited to younger patients, and to within the first 2 years after eradication.