Time Trends of the Impact of <b><i>Helicobacter pylori</i></b> Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients

Abstract

Background/Aims:Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers. The purpose of the present study was to elucidate the time trends of the impact of H. pylori infection and use of NSAIDs and/or antithrombotic agents on peptic ulcer bleeding (PUB) in Japanese patients. Methods: We retrospectively reviewed 719 patients who had received endoscopic hemostasis for PUB between 2002 and 2013. Subjects were divided into either the first-half group (2002-2007, n = 363) or the second-half group (2008-2013, n = 356). The clinical characteristics of the patients, including the prevalence of H. pylori infection and use of NSAIDs and antithrombotic agents, were compared between the two groups. Results: Compared to the first-half group, patients in the second-half group were characterized by older age (proportion of the patients above 60 years old, 63.9 vs. 76.7%, p = 0.0002), less frequent H. pylori infection (71.6 vs. 57.9%, p < 0.001) and more frequent NSAID intake (39.9 vs. 48.6%, p = 0.02). No significant difference was observed regarding the use of antithrombotic agents between the two groups (18.6 vs. 23.3%, p = 0.13). The prevalence of H. pylori infection and proportion of patients above 60 years old were significantly different between the two groups in a multivariate analysis. Conclusion: The main cause of PUB has clearly shifted from H. pylori infection to the use of NSAIDs over the last decade.

Key Issues Associated with <b><i>Helicobacter pylori</i></b> Eradication

“…The increase in the elderly population ( ≥ 65 years), combined with high rates of gonarthrosis and lumbago in older people, has led to a sharp increase in prescriptions of NSAIDs in recent years [11] . Because antiplatelet therapies, such as low-dosage aspirin (LDA), to reduce clotting have been shown to have secondary prevention benefits for myocardial and cerebral infarction patients, there has been a pronounced increase in patients on LDA regimens [12] , which has led to a higher incidence of PU associated with NSAIDs and LDA, often accompanied by hemorrhaging [13] .…”

The effect of statins on the occurrence of peptic ulcer

“…While the cases of H. pylori have been decreasing over the last decade due to improved cleanliness and eradication therapy, the rate of PUD has not decreased dramatically in some countries. This leads us to conclude that the usage of NSAIDs and aspirin in the elderly, then, is the reason why PUD is still common [12][13][14].…”

Questionnaire-Based Survey on Gastrointestinal Bleeding and Management of Antithrombotic Agents during Endoscopy Among Asian Countries

“…Some reports from Japan indicate that ulcers related to the use of nonsteroidal anti-inflammatory drugs, including low-dose aspirin, have been increasing [5, 6]. The H. pylori -positive population has recently been decreasing in Japan and is lower than that in OAC [7, 8].…”

“…However, the degree of gastric mucosal abnormalities (intestinal metaplasia, atrophy) in H. pylori -positive individuals is more severe in Japan than that in other areas of Asia [8, 9]. This difference is considered to be caused by interactions among the H. pylori strain, the infected host, and environmental factors [5, 6]. Additionally, the incidence of H. pylori -related bleeding peptic ulcers is higher in Japan than OAC, as is the incidence of H. pylori -related gastric cancer in Japan.…”