title: Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial.
abstract: BACKGROUND
  Whether Helicobacter pylori increases the risk of ulcers in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) is controversial. We hypothesised that eradication of H pylori infection would reduce the risk of ulcers for patients starting long-term NSAID treatment.
  
  
  METHODS
  Patients were enrolled if they were NSAID naïve, had a positive urea breath test, had dyspepsia or an ulcer history, and required long-term NSAID treatment. They were randomly assigned omeprazole triple therapy (eradication group) or omeprazole with placebo antibiotics (placebo group) for 1 week. All patients were given diclofenac slow release 100 mg daily for 6 months from randomisation. Endoscopy was done at 6 months or if severe dyspepsia or gastrointestinal bleeding occurred. The primary endpoint was the probability of ulcers within 6 months. Analyses were by intention to treat.
  
  
  RESULTS
  Of 210 arthritis patients screened, 128 (61%) were positive for H pylori. 102 patients were enrolled, and 100 were included in the intention-to-treat analysis. H pylori was eradicated in 90% of the eradication group and 6% of the placebo group. Five of 51 eradication-group patients and 15 of 49 placebo-group patients had ulcers. The 6-month probability of ulcers was 12.1% (95% CI 3.1-21.1) in the eradication group and 34.4% (21.1-47.7) in the placebo group (p=0.0085). The corresponding 6-month probabilities of complicated ulcers were 4.2% (1.3-9.7) and 27.1% (14.7-39.5; p=0.0026).
  
  
  CONCLUSIONS
  Screening and treatment for H pylori infection significantly reduces the risk of ulcers for patients starting long-term NSAID treatment.
authors.affiliation: Departments of Medicine and Therapeutics, The Chinese University of Hong Kong, Special Administrative Region of China, Hong Kong. fklchan@cuhk.edu.hk
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.forename: K F
authors.initials: KF
authors.lastname: To
authors.forename: Justin C Y
authors.initials: JC
authors.lastname: Wu
authors.forename: M Y
authors.initials: MY
authors.lastname: Yung
authors.forename: W K
authors.initials: WK
authors.lastname: Leung
authors.forename: Timothy
authors.initials: T
authors.lastname: Kwok
authors.forename: Y
authors.initials: Y
authors.lastname: Hui
authors.forename: Henry L Y
authors.initials: HL
authors.lastname: Chan
authors.forename: Cynthia S Y
authors.initials: CS
authors.lastname: Chan
authors.forename: Elsie
authors.initials: E
authors.lastname: Hui
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy; D003692:Delayed-Action Preparations; D004008:Diclofenac / Q000009:adverse effects* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D011336:Probability; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D003692:Delayed-Action Preparations; D004008:Diclofenac; D009853:Omeprazole