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Open AccessArticle

Role of Helicobacter pylori in Upper Gastrointestinal Bleeding Among Ischemic Stroke Hospitalizations: A Nationwide Study of Outcomes

1
Department of Neurology, Creighton University School of Medicine, Omaha, NE 68122, USA
2
Department of Internal Medicine, University of Nevada Reno School of Medicine, Las Vegas, NV 89102, USA
3
Department of Rehabilitation Medicine, Metropolitan Hospital Center, New York, NY 10029, USA
4
Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, USA
5
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Author to whom correspondence should be addressed.
Gastrointest. Disord. 2019, 1(3), 358-371; https://doi.org/10.3390/gidisord1030029
Received: 29 June 2019 / Revised: 29 August 2019 / Accepted: 30 August 2019 / Published: 3 September 2019
Introduction: Helicobacter pylori (H. pylori) is a well-recognized risk factor for upper gastrointestinal bleeding (UGIB). The exposure to tissue plasminogen activator (tPA), anti-platelets, and anticoagulants increases the risk of UGIB in acute ischemic stroke (AIS) patients, the risk stratification of H. pylori infection is not known. In this retrospective cross-sectional study, we aimed to evaluate the relationship between H. pylori and GIB in patients hospitalized with AIS. Methods: In the nationwide data, hospitalization for AIS was identified by primary diagnosis using International Classification of Diseases, clinical modification (ICD-9-CM) codes. Subgroup of patients with GIB and H. pylori were identified in AIS cohort. A stepwise multivariable logistic regression model was fitted to evaluate the outcome of upper GIB and role of H. Pylori in UGIB. Results: Overall 4,224,924 AIS hospitalizations were identified, out of which 18,629 (0.44%) had UGIB and 3122 (0.07%) had H. pylori. The prevalence of H. pylori-induced UGIB among UGIB in AIS was 3.05%. The prevalence of UGIB was markedly elevated among the H. pylori infection group (18.23% vs. 0.43%; p < 0.0001) compared to the non-H. pylori group. In multivariable regression analysis, H. pylori was associated with markedly elevated odds of UGIB (aOR:27.75; 95%CI: 21.07–36.55; p < 0.0001). Conclusion: H. pylori infection had increased risk-adjusted occurrence of UGIB amongst the AIS hospitalized patients. H. pylori testing may improve risk stratification for UGIB and lower the health care cost burden in stroke hospitalization. View Full-Text
Keywords: acute ischemic stroke; helicobacter pylori; gastrointestinal hemorrhage; tissue plasminogen activator; nationwide inpatient sample; gastrointestinal bleeding acute ischemic stroke; helicobacter pylori; gastrointestinal hemorrhage; tissue plasminogen activator; nationwide inpatient sample; gastrointestinal bleeding
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Patel, U.K.; Dave, M.; Lekshminarayanan, A.; Patel, N.; Lunagariya, A.; Jani, V.; Dhamoon, M.S. Role of Helicobacter pylori in Upper Gastrointestinal Bleeding Among Ischemic Stroke Hospitalizations: A Nationwide Study of Outcomes. Gastrointest. Disord. 2019, 1, 358-371.

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