Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding peptic ulcers in Japan.
BACKGROUND
Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) are well-known major causes of peptic ulcers. This study aimed to characterize the features of bleeding peptic ulcers in Japan.


METHODS
This prospective study evaluated 116 patients revealed to have bleeding peptic ulcers from January 2000 to December 2002.


RESULTS
Eighty-eight of the 116 patients (75.9%) had H. pylori infection. Seventy (60.3%) patients were positive for H. pylori with no history of NSAID use (group A), and 18 (15.5%) were positive for H. pylori with a history of NSAID use (group B). Among the H. pylori-negative patients, 15 (12.9%) were associated with NSAID use (group C). Thirteen (11.2%) patients had no H. pylori infection or history of NSAID use (group D). Among the 33 patients with a history of NSAID use, 11 were on-demand NSAID users and 14 took daily low-dose aspirin. The patients in groups B and C were significantly older that those in groups A and D, and they more frequently had coexisting diseases compared with group A. In group D, 11 patients had atrophic changes revealed by endoscopic examination, suggesting a past H. pylori infection, and these atrophic changes remained at the time of bleeding. Many of the patients in group D had serious comorbidity. Compared with healthy control subjects, the concentrations of both phosphatidylcholine and phosphatidylethanolamine were significantly decreased in the antral gastric mucosa in all patient groups.


CONCLUSIONS
NSAID use contributed to bleeding ulcers in 28.4% of patients; thus, low-dose aspirin or on-demand NSAID use may cause bleeding ulcers. There were only two (1.7%) confirmed cases of H. pylori-negative, non-NSAID ulcers.
Ootani
Hibiki
H
Department of Internal Medicine, Saga Medical School, Saga, 849-8501, Japan.
Iwakiri
Ryuichi
R
Shimoda
Ryo
R
Nakahara
Shin
S
Amemori
Sadahiro
S
Fujise
Takehiro
T
Kikkawa
Atsushi
A
Tsunada
Seiji
S
Sakata
Hiroyuki
H
Fujimoto
Kazuma
K
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004381:Duodenal Ulcer / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000150:complications* / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal