The effect of Helicobacter pylori infection on NSAID-related gastroduodenal damage in the elderly

Pilotto, Alberto; Franceschi, Marilisa; Leandro, Gioacchino; Mario, F. Di; Valerio, G.

doi:10.1097/00042737-199710000-00006

Cited by 60 publications

(32 citation statements)

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“…It was also reported that ulcer bleeding was more prevalent in patients with H pylori infections [26] . Conversely, certain studies have reported that positivity or negativity of H pylori in NSAID users made no significant difference [27,28] . In our study, H pylori positivity was not related to significant changes in LS or BS in patients who had taken acetaminophen and NSAIDs.…”

Section: Discussionmentioning

confidence: 94%

Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

Soylu¹,

Dolapcioglu²,

Dolay³

et al. 2008

WJG

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AIM:To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) with respect to some risk factors and patient characteristics. METHODS:The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion (group Ⅰ) with suicidal intent. Thirty patients with or without mild complaints of dyspepsia (group Ⅱ) were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score (LS), expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis. RESULTS: Gastroduodenal damage was significantly more severe in group Ⅰ compared to group Ⅱ (P < 0.01). The LS was similar in both groups Ⅰa and Ⅰb. However LS was significantly higher in patients who had ingested multiple NSAIDs (group Ⅰc) compared to other patients (P < 0.01). The LS was correlated to age (P < 0.01) and total amount of drug ingested (P < 0.05) in group Ⅰ; but it was not correlated with Helicobacter pylori (H pylori) infection or duration of exposure (P > 0.05). The biopsy score (BS) was higher in group Ⅰ than group Ⅱ (P < 0.01), and higher in group Ⅰb than group Ⅰa (P < 0.05). CONCLUSION: The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of highdose acetaminophen.

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Section: Discussionmentioning

confidence: 94%

Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

Soylu¹,

Dolapcioglu²,

Dolay³

et al. 2008

WJG

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“…H. pylori infection in elderly people is associated with an increase in NSAID‐related peptic ulcers, but not with a higher prevalence of upper gastrointestinal bleeding 20 . Indeed, both factors, NSAID use and H. pylori infection, were shown to be independent and unrelated risk factors for gastroduodenal bleeding in elderly subjects 21 , .…”

Section: Indications For Treatment In the Elderlymentioning

confidence: 97%

An approach toHelicobacter pyloriinfection in the elderly

Pilotto

Malfertheiner

2002

Aliment Pharmacol Ther

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The prevalence of Helicobacter pylori infection increases with age world‐wide, reaching levels of 40–60% in asymptomatic elderly subjects and over 70% in elderly patients with gastroduodenal diseases. However, the percentage of H. pylori‐positive elderly patients who are treated for their infection remains very low. Data are now available that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori‐associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent the progression of intestinal metaplasia and gastric atrophy. New studies are needed to clarify the role of eradication in elderly patients with non‐ulcer dyspepsia and gastro‐oesophageal reflux disease and in those who use non‐steroidal anti‐inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For non‐invasive monitoring of H. pylori infection after treatment, the 13C‐urea breath test has significantly higher accuracy than serology in the elderly; further studies are needed to clarify the role of the H. pylori stool antigen test in old age. One‐week proton pump inhibitor‐based triple therapy regimens, including clarithromycin, amoxicillin and/or nitroimidazoles, are highly effective and well tolerated in elderly patients. Low doses of both proton pump inhibitors and clarithromycin (in combination with standard doses of amoxicillin or nitroimidazoles) are sufficient. Low compliance and antibiotic resistance are the main factors related to treatment failure in old age.

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“…NSAID use was significantly related to an increased risk of bleeding both in patients with GUs and those with DUs, while H. pylori-positivity reduced the risk of bleeding. Paradoxically, in another case-control study of 128 elderly symptomatic NSAID users by the same group of investigators, 46 they found that H. pyloripositive patients had a significantly higher rate of gastric and duodenal ulcers than uninfected patients (74.3% compared with 53.7%; P ϭ 0.02). Dyspepsia.…”

Section: Case-control Studiesmentioning

confidence: 95%

Helicobacter pylori and nonsteroidal anti-inflammatory drugs. Approaching the end of the controversy in the new millennium, or room for more debate?

Leong

Chan

Sung

2001

Journal of Gastroenterology

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This article aims to review recent scientific, epidemiological, and clinical publications, and to examine this intricate interrelationship. Pathophysiological studiesIt is generally thought that H. pylori and NSAIDs damage the mucosa by different mechanisms. H. pylori infection induces mucosal inflammation and stimulates cytokine release, resulting in apoptosis. In contrast, NSAIDs inhibit mucosal prostaglandin (PG) synthesis, leading to weakening of the mucosal barrier and impaired resistance to acid injury. Several factors have been shown to be of importance in the pathogenesis of ulceration, and the effects of H. pylori infection and NSAID constitute a complex interaction. ApoptosisApoptosis (programmed cell death) is the mechanism of normal cell turnover of the mucosa throughout the gastrointestinal tract and maintains a fine balance with cell proliferation. 2 H. pylori directly induces apoptosis or indirectly by invoking the host inflammatoryimmune response. Zhu et al. 3 found that, individually, both NSAID use and H. pylori infection induced apoptosis. When H. pylori infection and NSAID were combined, NSAIDs actually abrogated the apoptosis induced by H. pylori infection. The latter observation led to the impression that H. pylori might ameliorate the mucosal injury induced by NSAIDs. In contrast, Leung et al. 4 showed that H. pylori-infected patients had a higher apoptotic activity than that in noninfected controls. Apoptosis was further increased in H. pyloriinfected patients after exposure to naproxen. Interestingly, the apoptotic effect of naproxen was significantly alleviated when H. pylori was eradicated prior to the administration of naproxen. 4

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The effect of Helicobacter pylori infection on NSAID-related gastroduodenal damage in the elderly

Cited by 60 publications

References 0 publications

Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

An approach toHelicobacter pyloriinfection in the elderly

Helicobacter pylori and nonsteroidal anti-inflammatory drugs. Approaching the end of the controversy in the new millennium, or room for more debate?

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