Helicobacter pylori and NSAID-induced gastric ulcer in a Japanese population

Abstract

A recent meta-analysis by Huang et al. clarified that Helicobacter pylori infection and nonsteroidal antiinflammatory drugs (NSAIDs) are important factors for peptic ulcer. The results showed that the risk for ulcer in NSAID(+)/H. pylori(+) patients was 61.1 fold higher when compared with NSAID(-)/H. pylori(-) patients. Some gastric ulcers detected in patients on NSAID therapy may actually be caused by H. pylori, but it is difficult to differentiate NSAID-induced gastric ulcer from H. pylori-induced gastric ulcer. Several studies have investigated the effects of H. pylori eradication on ulcer healing. One study reported that H. pylori eradication actually lowered the healing rate of gastric ulcers. Because there have been no studies finding that H. pylori eradication facilitates healing, H. pylori eradication is not recommended for NSAID users. Concerning the efficacy of H. pylori eradication in the prevention of NSAID-induced gastric ulcer, a meta-analysis concluded that among all patients on NSAID therapy, H. pylori eradication lowered the prevalence of ulcer, which was particularly marked in NSAID-naïve patients. When compared with those of proton pump inhibitors (PPIs), the preventative effects of H. pylori eradication were inferior. In Japan, national health insurance does not cover procedures that prevent or lower the risk for NSAID-induced ulcer. When administering NSAID to patients with risk factors, it is desirable to administer antiulcer agents.

Eradication of Helicobacter pylori Infection Reduces the Incidence of Peptic Ulcer Disease in Patients using Nonsteroidal Anti‐Inflammatory Drugs: A Meta‐Analysis

“…Five controlled studies compared the prevalence of H. pylori infection in NSAID users and non‐NSAID users with PUD (Table 1) [19–23]. Data show that NSAID use is not associated with H. pylori infection in patients with PUD (Fig.…”

“…Previously, some studies have shown that H. pylori infection is reversely associated with NSAID use in dyspeptic patients [19,21,22,28,36,37], whereas others failed to show the association [20]. In the past, studies solely either review the relation between H. pylori infection and NSAID drugs in peptic ulcer disease or role of H. pylori eradication in the prevention of peptic ulcer in NSAID users, but they have not combine above two aspects in a study.…”

Acid pump antagonist‐provoked HSP27 dephosphorylation and accentuation rescues stomach from indomethacin‐induced damages

“…However, in spite of these benefits of PPI use, there still exists commonly encountered questions in clinical practice regarding PPI prescription; the uncertain role of PPIs in the primary prevention, healing, and secondary prevention of NSAID/aspirin‐induced gastroduodenal ulceration; the ambiguous role of PPIs in the prevention of adverse clinical outcomes related to NSAID/aspirin use; the risk of PPIs in preventing rebleeding from aspirin ± clopidogrel therapy; and not documented cost‐effectiveness and existing limitations to the use of PPIs 19 . Furthermore, it should be underlined that H. pylori infection positively counteracts with the gastroprotective effect of PPIs 20 …”

A cohort study investigating medication management by pharmacists to prevent drug-related problems in pain therapy

“…They also inhibit thrombocyte function, leading to an increased risk of bleeding. Especially in the elderly, as in our patient group, NSAIDs pose a particular risk of causing gastric ulcer 23. Opioids, on the contrary, can lead to adverse events that go along with a reduced quality of life.…”