S685 H. pylori Testing in Patients Admitted for Upper GI Bleeding Due to Peptic Ulcer Disease: A Quality Improvement Project

Introduction: H. pylori infection is associated with peptic ulcer disease and gastric cancer. Upper GI bleeding is a serious complication of peptic ulcer disease (PUD). According to 2017 ACG Clinical Guidelines for treatment of H. pylori infection, all patients with PUD should be tested and appropriately treated for H. pylori if positive to minimize risk of rebleeding. H. pylori tests that identify active infection are preferred such as fecal antigen test, urea breath test or mucosal biopsy during endoscopy. In patients with documented history of peptic ulcer disease, it is acceptable to use H. pylori antibody testing given high pretest probability of H. pylori infection. Methods: We performed a retrospective chart review of patients admitted in the hospital for any signs of upper GI bleeding (hematemesis, coffee ground emesis or melena) with endoscopic evidence of peptic ulcer disease from January 2020 to December 2020. Patients were excluded if they were less than 18 years of age or without any evidence of peptic ulcer disease on upper GI endoscopy. Data was collected including basic demographics, endoscopy findings and H. pylori testing status. Results: During the study period, 60 patients had abnormal findings on esophagogastroduodenoscopy (EGD) when performed for upper GI bleeding. Peptic ulcer disease (PUD) was identified as source of bleeding in 27 (45%) patients and esophagitis was identified as source of bleeding in 20 patients (33.3%). Among patients with peptic ulcer disease, 18 (67%) were male. Mean age was 62 ± 15 years. Most of the patients with PUD had H. pylori testing (77.8%) with gastric biopsies. All 21 patients with endoscopic low-risk stigmata of bleeding (Forrest IIc, III) had H. pylori testing. 9 (42.9%) patients were tested positive for H. pylori. 6 patients had PUD with high-risk stigmata of bleeding (Forrest Ia, Ib, IIa and IIb). None of these patients with high-risk stigmata of bleeding had H. pylori testing. Conclusion: Majority of patients with PUD and endoscopic low-risk stigmata of bleeding had H. pylori testing with high positivity rate. However, patients with peptic ulcer disease and high-risk stigmata of bleeding were less likely to be tested for H. pylori due to concern for biopsy induced bleeding. In the second phase of this study, we aim to educate providers to use non-invasive methods to test for H. pylori in high-risk patients and assess improvement in H. pylori testing after the educational intervention.