Increased prevalence of Helicobacter pylori infection in critically ill patients with stress ulceration

Introduction

H. pylori is known for its causative role in gastric and duodenal ulcer disease. However, it is unknown whether H. pylori plays a role in the formation of stress ulceration in critically ill patients. Therefore we studied the presence of H. pylori infection in critically ill patients on admission to the intensive care and the relation to gastric and duodenal mucosal injury.

Methods

Inclusion criteria were admittance to the intensive care unit for emergency reasons and the need for mechanical ventilation. H. pylori was detected by the Laser Assisted Ratio analyser-¹³C-urea breath test (UBT). Upper gastro-intestinal endoscopy was performed in all patients by the same endoscopist who was blinded for the results of the H. pylori test. Breath test and endoscopy were performed within 6 h after admission. Gastric and duodena mucosal injury were assessed according to the so called Brown scoring system [1]; grade 0, normal mucosa; grade 1, 1 to 5 crosions or submucosal hemorrhages; grade 2, 6 to 20 erosions or hemorrhages; grade 3, more than 20 erosions or hemorrhages.

Results

Fifty consecutive patients were included. In seven patients the (UBT was unable to be processed (n = 6) or endoscopy was inadequate (n = 1). Of 43 eligible patients 21 were H. pylori positive and 22 were H. pylori negative. Of 28 patients who had a mucosa injury grade 0 or 1 nine were H. pylori positive (32%) and mean APACHE II score was 25.6. Of 15 patients who had a mucosal injury score 2 or 3, 12 were H. pylori positive (80%) and mean APACHE II score was 25.5. H. pylori infection was significantly associated with mucosal injury gradation 2 or 3 (P = 0.003, Pearson Chi-square, odds ratio 8.4 and relative risk 4.2).

Conclusion

The severity of gastric and duodenal mucosal injury in critically ill patients during mechanical ventilation is significantly related to the presence of H. pylor i infection.