Role of Helicobacter pylori infection on NSAIDs-related upper gastrointestinal bleeding in the elderly

Interaction between nonsteroidal anti-inflammatory drug intake and calcium-channel blocker-based antihypertensive treatment in the Syst-Eur trial

“…1,5,10,24,25 Many reports, most case-control studies, investigated whether use of CCBs was associated with a higher risk of (gastrointestinal) bleeding. 5,12,[15][16][17][18][19] Several in vitro studies reported that the concurrent administration of (a low dose of) ASA or another NSAID with a CCB synergistically inhibits platelet aggregation [26][27][28][29] while in vivo experiments showed inconsistent results. 30,31 However, the question of an interaction between CCB intake and NSAID intake on the incidence of bleeding was not specifically addressed in any study.…”

“…13 Furthermore, in a prospective cohort study, Pahor et al 14 reported an increased risk of upper gastrointestinal bleeding associated with the use of CCBs, but several other investigators, using data from cohort 12 or casecontrol studies [15][16][17][18][19] could not confirm Pahor's results. 14 In this post-hoc analysis of the Syst-Eur data we examined the relationship between NSAID intake and outcome.…”

Effect of treatment of Helicobacter pylori on the prevention of gastroduodenal ulcers in patients receiving long‐term NSAIDs: a double‐blind, placebo‐controlled trial

“…[9][10][11][12] It has been suggested that the presence of H. pylori may confer protection against ulcer bleeding, especially gastric ulcer bleeding. [10][11][12] The most direct evidence of an interaction between H. pylori and NSAIDs comes from studies investigating the effects of H. pylori eradication on the development of ulcers in NSAID users. The eradication of H. pylori has been shown to be beneficial in patients without previous NSAID exposure and no history of ulcers.…”

“…In the intention-to-treat analysis, five patients (7.1%; 95% CI, 2-16) in the treatment group developed peptic ulcers (all gastric ulcers) at the end of 12 weeks, compared with six patients (8.6%; 95% CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] in the placebo group (four gastric ulcers and two duodenal ulcers) (P ¼ 1.00). The ulcer size ranged from 5 to 12 mm.…”

Helicobacter pylori infection is a protective factor for bleeding gastric ulcers but not for bleeding duodenal ulcers in NSAID users

“…This ®nding is coincident with other previously reported studies. 2,3 Review of the individual data for both duodenal and gastric ulcers from these studies indicates that NSAID use was identi®ed as a risk factor for gastric ulcer bleeding but H. pylori infection was not, and that interaction of both factors decreased the risk of upper gastrointestinal bleeding, especially in gastric ulcers.…”