Helicobacter pylori eradication may reduce the risk of gastroduodenal lesions in chronic NSAID users.
Helicobacter pylori and non-steroidal anti-inflammatory drugs are two of the most common causes of peptic ulceration. The aim of this review is to assess the possible inter-relationships between Helicobacter pylori and non-steroidal anti-inflammatory drugs in the pathogenesis of gastric and duodenal erosions and ulcers, with the aim of assessing if the presence of Helicobacter pylori is likely to increase the likelihood of non-steroidal anti-inflammatory drug-related gastroduodenal symptoms and lesions, and if eradication of Helicobacter pylori may reduce or prevent non-steroidal anti-inflammatory drug lesions. There appears to be more likelihood of dyspeptic symptoms in patients on long-term non-steroidal anti-inflammatory drugs when Helicobacter pylori is present. The balance of evidence also suggests that peptic ulcers and erosions in patients on long-term non-steroidal anti-inflammatory drugs may be more likely to occur in patients who are Helicobacter pylori positive compared to those who are Helicobacter pylori negative. Although Helicobacter pylori and non-steroidal anti-inflammatory drugs both increase the risk of peptic ulcer bleeding, the risk does not appear to be additive. There is increasing evidence from prospective studies that eradication of Helicobacter pylori may reduce the incidence of ulcers in patients on non-steroidal anti-inflammatory drugs. More prospective long-term studies are required. If Helicobacter pylori is confirmed to be a factor in this respect, it will aid in the targeting of patients at greatest risk of developing ulcers in patients on long-term non-steroidal anti-inflammatory drugs. Those at greatest risk are elderly patients, especially females, smokers, patients with a previous ulcer history, severe or debilitating arthritis or who have other chronic diseases. The addition of Helicobacter pylori to this list and its subsequent eradication may improve the outlook for these patients and help in the effective targeting of patients at greatest risk who are on long-term non-steroidal anti-inflammatory drugs.
Russell
R I
RI
Department of Gastroenterology, Royal Infirmary, Glasgow, Scotland.
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000382:microbiology*; D012307:Risk Factors; D013270:Stomach / Q000382:microbiology
D000894:Anti-Inflammatory Agents, Non-Steroidal