title: [Impact of Helicobacter pylori infection on the risk of gastro-duodenal ulcer in patients treated with nonsteroidal antiinflammatory drugs].
abstract: The interaction of Helicobacter pylori (H. pylori) and non steroidal anti-inflammatory drugs (NSAIDs) on the development of gastro-duodenal ulcers and their complications is complex and controversial. From a clinical point of view, the question is whether or not H. pylori infection should be tested and eradicated in patients treated or about to be treated by NSAIDs or low-dose aspirin. Contradictory results have been reported in epidemiological studies. Recent data suggest that H. pylori-NSAID interaction may be different depending on the type of treatment, non aspirin NSAIDs or low-dose aspirin, the gastric or duodenal localization of ulcer and the strains of H. pylori. Controlled randomized studies suggest that eradication of H. pylori may be beneficial in NSAID-naïve patients but not in those already on long term NSAID therapy. Recommendations are proposed for different subgroups of patients. In NSAID users presenting with gastro-duodenal ulcer or complications, H. pylori screening and eradication are indicated. In patients treated or about to be treated by NSAIDs, the "test and treat" H. pylori strategy is recommended if there is a history of gastroduodenal ulcer or complications. Whether this strategy should be generalized preventively in patients without ulcer history is still controversial and deserves further studies.
authors.affiliation: Service d'Hépato-Gastroentérologie, CHU Robert-Debré, rue Général-Koenig, 51092 Reims Cedex. gthiefin@chu-reims.fr
authors.forename: Gérard
authors.initials: G
authors.lastname: Thiéfin
authors.forename: Damien
authors.initials: D
authors.lastname: Jolly
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D016481:Helicobacter Infections / Q000150:complications* / Q000503:physiopathology; D016480:Helicobacter pylori; D006801:Humans; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
vernacular_title: Impact de l'infection à Helicobacter pylori sur le risque de complications gastro-duodénales des traitements anti-inflammatoires non stéröidiens.