title: Peptic Ulcer Bleeding Risk. The Role of Helicobacter Pylori Infection in NSAID/Low-Dose Aspirin Users.
abstract: OBJECTIVE
  Helicobacter pylori (H. pylori) infection and NSAID/low-dose aspirin (ASA) use are associated with peptic ulcer disease. The risk of peptic ulcer bleeding (PUB) associated with the interaction of these factors remains unclear. The objective of this study was to determine the risk of PUB associated with the interaction between H. pylori infection and current nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose ASA use.
  
  
  METHODS
  This was a case-control study of consecutive patients hospitalized because of PUB. Controls were matched by age, sex, and month of admission. H. pylori infection status was determined in all cases and controls by serology. Drug use was determined by structured questionnaire. Adjusted relative risk (RR) associated with different factors, and the interaction between NSAID/ASA and H. pylori infection was estimated by logistic regression analysis.
  
  
  RESULTS
  The study included 666 cases of PUB and 666 controls; 74.3% cases and 54.8% controls (RR: 2.6; 95% confidence interval (CI): 2.0-3.3) tested positive for H. pylori infection; 34.5% of cases had current NSAID use compared with 13.4% of controls (RR: 4.0; 95% CI: 3.0-5.4). Respective proportions for low-dose ASA use were 15.8 and 12%, respectively (RR: 1.9; 95% CI: 1.3-2.7). The RR of PUB for concomitant NSAID use and H. pylori infection suggested an additive effect (RR: 8.0; 95% CI: 5.0-12.8), whereas no interaction was observed with ASA use (RR: 3.5; 95% CI: 2.0-6.1).
  
  
  CONCLUSIONS
  NSAID, low-dose ASA use, and H. pylori infection are three independent risk factors for the development of PUB, but there were differences in the interaction effect between low-dose ASA (no interaction) or NSAID (addition) use and H. pylori infection, which may have implications for clinical practice in prevention strategies.
authors.affiliation: Universitary Hospital Lozano Blesa, Gastroenterology Unit, Zaragoza, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Sostres
authors.affiliation: CIBERehd, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Carrera-Lasfuentes
authors.affiliation: Universitary Hospital Lozano Blesa, Microbiology Unit, Zaragoza, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Benito
authors.affiliation: Health Science Institute of Aragon, Zaragoza, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Roncales
authors.affiliation: Health Science Institute of Aragon, Zaragoza, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Arruebo
authors.affiliation: Universitary Hospital Lozano Blesa, Gastroenterology Unit, Zaragoza, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Arroyo
authors.affiliation: Universitary Hospital of Donostia, San Sebastian, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Bujanda
authors.affiliation: CEIFE, Madrid, Spain.
authors.forename: L A
authors.initials: LA
authors.lastname: García-Rodríguez
authors.affiliation: 1] Universitary Hospital Lozano Blesa, Gastroenterology Unit, Zaragoza, Spain [2] CIBERehd, Madrid, Spain [3] Health Science Institute of Aragon, Zaragoza, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lanas
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000382:microbiology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin