Bleeding duodenal ulcer: comparison between Helicobacter pylori positive and Helicobacter pylori negative bleeders.

BACKGROUND AND AIMS: To provide a direct comparison of Helicobacter pylori-positive subjects bleeding from duodenal ulcer with H. pylori-negative ones, in terms of severity of bleeding and outcome. PATIENTS AND METHODS: A case-control study was prospectively conducted in 105 H. pylori-negative duodenal ulcer bleeders and same number of sex- and age-matched H. pylori-positive ones. RESULTS: NSAID consumption was more common among H. pylori-negative subjects (81%) compared to their H. pylori-positive counterparts (58.1%, P < 0.001). H. pylori-negative bleeders were found to need more often haemostasis (55.2% versus 31.4%, P < 0.001) or surgical intervention (15.2% versus 4.8%, P = 0.011) and to have a greater proportion of rebleeding (32.4% versus 13.3%, P = 0.001), a more prolonged hospitalisation (11.6 +/- 4.1 versus 6.2 +/- 1.5 days, P < 0.001) and a higher rate of in-hospital mortality (15.2% versus 3.8%, P = 0.005). In the overall population (N = 210), H. pylori negativity, among other known risk factors, emerged as independent predictor (odds ratio: 3.2; 95% CI: 1.5, 11.2; P = 0.004) of an unfavourable outcome (surgery or death). CONCLUSIONS: Duodenal ulcer bleeding in H. pylori-negative subjects appears to be more severe, to have a higher rate of rebleeding, and to lead more often to surgery or fatality compared to the vast majority of H. pylori-positive duodenal ulcer bleeders.

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke.

PURPOSE: To develop a simple and reliable diagnostic tool for differentiation of cerebral infarction (CIF) from intracerebral haemorrhage (ICH) in order to aid clinicians to decide about starting antiplatelet therapy in settings where rapid access to computed tomography (CT) is lacking. METHODS: Thirty variables regarding each patient admitted with acute stroke were recorded and considered in a logistic regression analysis using ICH as end-point (internal study). CT was used as the golden standard. The score derived was validated with data from the next consecutive stroke patients and was compared with the three preexisting scores (external validation study). RESULTS: Amongst 235 patients (119 males, mean age 70.6 +/- 11.2 years) of the internal study, 43 (18.3%) had ICH. Four independent correlates of ICH were identified and used for the derivation of the following integer-based scoring system: number of points=6 * (neurological deterioration within 3 h from admission) + 4 * (vomiting) + 4 * (WBC > 12 000) + 3 * (decreased level of consciousness). In the external study [168 patients, 85 males, mean age 70.2 +/- 10.8 years, 31 (18.5%) with ICH], when the cut-offs < or =3 points for CIF and > or =11 points for ICH were used, sensitivity, specificity, and positive and negative predictive values of the score for detection of stroke type were 97, 99, 97 and 99%, respectively; exceeding noticeably the three previously proposed systems. CONCLUSIONS: The proposed model provides an easy to use tool for sufficiently accurate differentiation between haemorrhagic and nonhaemorrhagic stroke on the basis of information available to all physicians early after admission.