JAMA

ESC 2025: Routine H. pylori screening post-MI shows no significant bleeding benefit

September 4, 2025

Routine H. pylori screening during myocardial infarction (MI) hospitalization doesn’t support widespread implementation for upper GI bleeding (UGIB) prevention in low-prevalence settings, according to research presented at ESC Congress 2025. However, targeted screening may be beneficial in high-risk subgroups, such as those with anemia or in regions with higher H. pylori prevalence.

Study details: HELP-MI SWEDEHEART (NCT05024864) was a cluster randomized, crossover, registry-based trial conducted across 35 Swedish hospitals. Adult patients (N=18,466) hospitalized with acute type 1 MI were randomized to either routine H. pylori screening or usual care. After one year, clusters crossed over to the alternate strategy. Primary endpoint: UGIB; secondary endpoints: all-cause and cardiovascular mortality, recurrent MI, stroke, and heart failure.

Results: Routine H. pylori screening didn’t significantly reduce UGIB (4.1% vs. 4.6%; rate ratio 0.90; 95% confidence interval, 0.77-1.05; p=0.18). No differences were observed in secondary outcomes. Subgroup analyses suggested potential benefit in patients with anemia, but these findings were exploratory. Per-protocol analyses showed lower UGIB rates in patients who tested positive and received eradication therapy.

Sources:

(2025, September 1). European Society of Cardiology. Routine Helicobacter pylori screening does not significantly reduce upper gastrointestinal bleeding in patients after a heart attack. [News release]. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Routine-Helicobacter-pylori-screening-does-not-significantly-reduce-upper-gastrointestinal-bleeding-in-patients-after-a-heart-attack

Hofmann R, et al. (2025, September 1). JAMA. Helicobacter pylori Screening After Acute Myocardial Infarction: The Cluster Randomized Crossover HELP-MI SWEDEHEART Trial. https://pubmed.ncbi.nlm.nih.gov/40887995/