Helicobacter pylori and nonsteroidal anti-inflammatory drugs in perforations and bleeding of peptic ulcers.
BACKGROUND
This study was designed to assess the relative contribution of H pylori (Hp) infection and NSAID in the pathogenesis of perforation and bleeding of peptic ulcer (PU).


METHODS
Total of 91 PU perforations and 135 active bleeding were examined during last 5 years. At the same time, 1384 age- and gender-matched PU patients without such complications were examined. Furthermore, the effects of various concentrations of aspirin on the growth of Hp isolated from antral mucosa of these PU were examined in vitro.


RESULTS
The average rates of Hp prevalence in PU patients with perforation or bleeding in NSAID intake were, respectively, only 50% and 62% as compared to 70.7 and 74% in PU patients non-using NSAID. The Hp prevalence in perforated and bleeding PU at all ages, particularly those at age of 60 years or higher, were significantly lower compared to that found below this age, while no such difference in Hp infection rate was seen in PU not using NSAID. In vitro studies on CagA and VacA positive Hp subjected to culture medium containing aspirin showed a dose dependent reduction in bacterial growth with complete bacteria killing occurring at 500 microg/ml of aspirin.


CONCLUSIONS
The Hp prevalence, especially in older PU patients using NSAID, is significantly lower in perforated and bleeding PU compared to that in non-complicated PU, and this could be explained by direct suppression of Hp by NSAID used by these patients.
Bobrzyński
Andrzej
A
Department of Surgery, Jagiellonian University Medical College, Cracow, Poland.
Konturek
Peter C
PC
Konturek
Stanisław J
SJ
Płonka
Małgorzata
M
Bielański
Władyslaw
W
Karcz
Danuta
D
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001944:Breath Tests; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications* / Q000453:epidemiology; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin