H pylori eradication reduces risk of peptic ulcers for patients taking non-steroidal anti-inflammatory drugs

January 03, 2002

N.B. Please note that if you are outside North America the embargo date for Lancet Press Material is 0001 hours UK time Friday 4th January 2002.

Screening and treatment for infection caused by the gastrointestinal bacterium Helicobacter pylori could substantially reduce the risk of ulcers for patients starting long-term non-steroidal anti-inflammatory drug (NSAID) treatment, conclude authors of a study in this week's issue of THE LANCET. A meta-analysis also published in this week's issue confirms both H pylori and NSAIDs as independent risk factors for peptic-ulcer disease.

Whether H pylori increases the risk of ulcers in patients taking NSAIDs is controversial. Francis Chan and colleagues from Prince of Wales Hospital, Hong Kong, hypothesised that eradication of H pylori would reduce the risk of ulcers for patients starting long-term NSAID treatment.

Patients requiring long-term NSAIDs were randomly assigned omeprazole triple therapy (eradication group) or omeprazole with placebo instead of 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.

Of 210 arthritis patients screened,100 patients were enrolled in the study. 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% in the eradication group and 34% in the placebo group. The corresponding 6-month probabilities of complicated ulcers were 4% and 27%, respectively.

A meta-analysis (p 14) by Richard Hunt and colleagues from McMaster University Medical Center, Canada, pooled data from previous studies about H pylori, NSAID use, and peptic-ulcer disease. In 16 studies of 1625 NSAID takers, uncomplicated peptic-ulcer disease was more than twice as likely in patients positive for H pylori than in those negative for H pylori. H pylori infection and NSAID use increased the risk of ulcer bleeding 1.79 and 4.85 fold, respectively. However, the risk of ulcer bleeding increased by a factor of 6.13 when both factors were present.
See also Commentary (p 3).

Contact: Dr Francis K L Chan, Department of Medicine & Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong; T) +852 2632 3126; F) +852 2637 3852; E) fklchan@cuhk.edu.hk

Professor Richard Hunt, Division of Gastroenterology, Department of Medicine, McMaster University Medical Center, Hamilton, Ontario L8N3Z5, Canada; T) +1 905 521 2100 Ext. 73219; E) huntr@mcmaster.ca


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