Association Between Depression and Recurrence of Peptic Ulcer Disease in Older Chinese Patients after Helicobacter Pylori Eradication: A Three-Year Study

Abstract

Background: Both Helicobacter pylori-infected peptic ulcer disease (PUD) and depression are common in older adults. Although H. helicobacter eradication has significantly reduced the risk of PUD recurrence, it remains unknown whether such therapy achieves comparable effect among older patients with and without depression. Aim: To compare PUD recurrence rates in depressed and non-depressed older patients after successful H. pylori eradication, and to evaluate the prospective effect of self-reported and diagnosed depression on PUD recurrence. Methods: 978 older patients with previous H. pylori-infected PUD were included after H. pylori eradication, and followed for up to 36 months. Using endoscopic examination, PUD recurrence rates among depressed and non-depressed older patients were compared. Multivariate logistic regression was performed to ascertain the prospective relationship between depression and PUD recurrence. Results: PUD recurrence rate was higher in patients with self-reported depression (10.9%) than those without (6.2%). Apart from self-reported depression (OR 2.418 (1.232, 4.989), other significant predictors of PUD recurrence included H. pylori reinfection (OR 2.815 (1.198, 4.687), cigarette smoking (OR 2.318 (1.238, 4.862), excessive alcohol drinking (OR 2.287 (1.118, 4.677), high green tea consumption (OR 2.107 (1.025, 4.325), regular ingestion of acetaminophen (OR 2.273 (1.238, 4.218) and NSAIDs (OR 3.341 (2.174, 5.187), as well as regular (OR 3.372 (2.087, 5.298), occasional (OR 3.096 (2.032, 5.162), and infrequent aspirin consumption (OR 2.645 (1.218, 4.562). Similar results were yielded on the association between diagnosed depression and PUD recurrence. Conclusion: PUD recurrence following H. pylori eradication is higher in depressed than in non-depressed older patients. PUD recurrence is also attributed by other clinical and behavioral factors. Results of this study sheds lights on the pathways underlying the association between multidimensional factors and PUD recurrence, which provides important implication for clinical practice in geriatric settings.