Targeted H. pylori screening Shows Promise for Reducing Bleeding Risk After Heart Attack
Stockholm, sweden – Routine screening for the stomach bacterium Helicobacter pylori isn’t necessary for all patients following a myocardial infarction (heart attack), but targeted testing could substantially reduce gastrointestinal bleeding risk in specific high-risk groups, according to a large new study published in JAMA. Researchers from Karolinska Institutet and Södersjukhuset in Sweden found a notably strong benefit for patients with anemia.The randomized study,involving nearly 18,500 heart attack patients across 35 Swedish hospitals,investigated whether screening for H.pylori – a common cause of gastritis and gastric ulcers – and subsequent treatment could lower the incidence of upper gastrointestinal bleeding, a serious complication affecting approximately 2% of patients within a year of a heart attack and linked to increased mortality and recurring cardiovascular events.
While overall results didn’t show a statistically significant reduction in bleeding across the entire study population,analysis of subgroups revealed a clear benefit. Patients with moderate to severe anemia experienced roughly half the rate of gastrointestinal bleeding when undergoing H. pylori screening and treatment compared to those receiving standard care. A positive effect was also observed in patients with kidney failure.
“Our results suggest that screening for Helicobacter pylori does not need to be done routinely for all individuals following a heart attack,” explained Dr. Robin Hofmann,led author of the study,senior consultant at the Department of Cardiology,Södersjukhuset,and associate professor at the Department of Clinical Science and Education,Södersjukhuset,Karolinska Institutet. ”On the other hand,testing and treatment could be a meaningful complement for selected patient groups with an elevated risk of bleeding.”
The study involved testing half the group for the bacterium and treating those who tested positive with antibiotics and protein pump inhibitors. The other half received standard post-infarction care without additional H. pylori testing or treatment. Follow-up lasted almost two years.
Researchers are now planning further examination into the long-term effects of targeted screening and aim to refine identification of the patient groups who would benefit most.
The study was funded by the Swedish Research council, the Swedish Heart Lung Foundation, and Region Stockholm, and conducted in collaboration with Södersjukhuset, Region Stockholm and the Uppsala Clinical Research Centre (UCR).
Source: Hofmann, R.,et al. (2025). Helicobacter pylori Screening After Acute Myocardial Infarction. JAMA. doi.org/10.1001/jama.2025.15047
