H. pylori Screening Unlikely to Lower Upper Gastrointestinal Bleeding Risk After Heart Attack, Study Shows

A recent large-scale trial has found that routine screening for Helicobacter pylori (H. pylori) infection does not significantly reduce the risk of upper gastrointestinal (GI) bleeding in patients hospitalized for myocardial infarction (MI). Presented at the ESC Congress 2025 and published simultaneously in JAMA, this research challenges the potential benefits of systematic H. pylori screening in post-heart attack care.

The study, known as the HELP-MI SWEDEHEART trial, involved over 18,000 patients across 35 Swedish hospitals in a cluster randomized crossover design. Participants were subjected to bedside 13C-urea breath testing to identify H. pylori infection during their MI hospitalization. Those diagnosed received eradication therapy, with the primary focus being the incidence of upper GI bleeding over a median follow-up of nearly two years.

Results indicated that 4.1% of patients in the screening group experienced upper GI bleeding, compared to 4.6% in the usual care group—a difference that was not statistically significant. Subgroup analyses showed some indication that patients with anemia might benefit from screening, with lower bleeding rates observed among those with mild to moderate-to-severe anemia.

Despite the fact that 70.1% of patients in the screening arm were tested for H. pylori, the overall evidence suggests that systematic screening in this setting does not confer a clear benefit in reducing bleeding risks. Dr. Robin Hofmann, the principal investigator, notes that while H. pylori is associated with gastrointestinal bleeding and common among cardiovascular patients, the infection rates in their study population were relatively low.

He further emphasizes that these findings might differ in populations with higher H. pylori prevalence or among those with particular risk factors like anemia. Currently, the data do not support routine H. pylori screening solely to prevent GI bleeding post-MI, but targeted strategies could still hold promise for specific patient groups.