title: Non-steroidal anti-inflammatory drugs, Helicobacter pylori and bleeding gastric ulcer.
abstract: BACKGROUND
  Helicobacter pylori infection and NSAID usage are considered to be independent risk factors for gastric ulcer (GU). Whether they interact to influence the risk of bleeding in GU is unclear.
  
  
  OBJECTIVE
  To determine the prevalence of H. pylori infection and NSAID ingestion in a group of patients with GU and determine their roles in bleeding and non-bleeding GU.
  
  
  RESULTS
  From January 1993 to June 1996, a total of 217 GU patients (150 male, 67 female, median age 61 years, range 26-94) were eligible for the study. Eighty-five per cent were H. pylori-positive and 15% were H. pylori-negative. NSAID usage within 4 weeks prior to endoscopy was present in 30%, more in the H. pylori-negative than H. pylori-positive patients (59% vs. 25% P = 0.0002). Aspirin was most commonly used (43%). One hundred patients bled from GU (69 male, 31 female, mean age 67 years, range 26-94) and 117 did not (81 male, 36 female, mean age 57 years, range 28-86). Univariate logistic regression showed that advanced age (>/= 65 years) and NSAID usage carried an increased risk of bleeding GU (odds ratio 3.4 and 6.8, respectively) while H. pylori infection alone was not associated with additional risk (OR = 0.8). However, when three variables were considered jointly in a multiple logistic regression, the OR associated with H. pylori infection increased to 2.4, suggesting that in the presence of NSAIDs and advanced age, H. pylori also increases the risk of bleeding GU, indicating an interaction between the variables.
  
  
  CONCLUSIONS
  NSAID usage and advanced age are risk factors for bleeding GU, whereas H. pylori infection by itself is not. In the presence of NSAIDs and advanced age, an increased risk of bleeding GU with H. pylori is observed, indicating the possibility of an interaction between these factors.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore.
authors.forename: T M
authors.initials: TM
authors.lastname: Ng
authors.forename: K M
authors.initials: KM
authors.lastname: Fock
authors.forename: J L
authors.initials: JL
authors.lastname: Khor
authors.forename: E K
authors.initials: EK
authors.lastname: Teo
authors.forename: C S
authors.initials: CS
authors.lastname: Sim
authors.forename: A L
authors.initials: AL
authors.lastname: Tan
authors.forename: D
authors.initials: D
authors.lastname: Machin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy*; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin