Korean J Gastroenterol.  2014 Aug;64(2):70-75. 10.4166/kjg.2014.64.2.70.

Helicobacter pylori Infection in Nonsteroidal Anti-inflammatory Drug Users

• Lim YJ
• Hong SJ

• KMID: 2164415
• DOI: http://doi.org/10.4166/kjg.2014.64.2.70

Abstract

NSAID-induced upper gastrointestinal (GI) damage occurs easily in people with a prior history of complicated or uncomplicated ulcers. Many recent clinical studies have proved the benefit of Helicobacter pylori eradication in NSAID users; however, the exact pathophysiologic relationship between concomitant H. pylori infection and NSAID use has not yet been fully elucidated. Testing and eradication of H. pylori are generally recommended in patients who are at a high risk for NSAID-induced GI damage. However, in high-risk patients, ulcer prophylaxis with proton pump inhibitor or misoprostol is needed even if H. pylori has been successfully eradicated. In low-risk patients, it is still questionable whether or not eradication of H. pylori can reduce upper GI damage. However, in western countries, due to its cost effectiveness, testing and eradication of H. pylori is recommended before starting aspirin or NSAID irrespective of the risk level. In regions with a high prevalence of H. pylori infection (>20%), the usefulness of testing and eradication of H. pylori has not yet been determined.

Keyword

Anti-inflammatory agents, non-steroidal; Helicobacter pylori; Peptic ulcer

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use
Aspirin/therapeutic use
Helicobacter Infections/*drug therapy
*Helicobacter pylori
Humans
Peptic Ulcer/*etiology
Proton Pump Inhibitors/therapeutic use
Risk Factors
Anti-Inflammatory Agents, Non-Steroidal
Aspirin
Proton Pump Inhibitors

Reference

References

1. Malfertheiner P, Megraud F, O'Morain CA, et al. European Helicobacter Study Group. Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report. Gut. 2012; 61:646–664.

2. Leung Ki EL, Chan FK. Helicobacter pylori infection and non-steroidal anti-inflammatory drug use: eradication, acid-reducing therapy, or both? Clin Gastroenterol Hepatol. 2012; 10:831–836.

3. Tang CL, Ye F, Liu W, Pan XL, Qian J, Zhang GX. Eradication of Helicobacter pylori infection reduces the incidence of peptic ulcer disease in patients using nonsteroidal anti-inflammatory drugs: a metaanalysis. Helicobacter. 2012; 17:286–296.

4. Backert S, Clyne M. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2011; 16(Suppl 1):19–25.

5. Hawkey CJ. What consideration should be given to Helicobacter pylori in treating nonsteroidal anti-inflammatory drug ulcers? Eur J Gastroenterol Hepatol. 2000; 12(Suppl 1):S17–S20.

6. Lanza FL, Chan FK, Quigley EM. Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104:728–738.

7. Leontiadis GI, Sreedharan A, Dorward S, et al. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technol Assess. 2007; 11:iii–iv. 1–164.

8. Song HJ, Kwon JW, Kim N, Park YS. Cost effectiveness associated with Helicobacter pylori screening and eradication in patients taking nonsteroidal anti-inflammatory drugs and/or aspirin. Gut Liver. 2013; 7:182–189.

9. You JH, Lau W, Lee IY, et al. Helicobacter pylori eradication prior to initiation of long-term non-steroidal anti-inflammatory drug therapy in Chinese patients-a cost-effectiveness analysis. Int J Clin Pharmacol Ther. 2006; 44:149–153.

10. Chan FK, Sung JJ, Chung SC, et al. Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet. 1997; 350:975–979.

11. Chan FK, To KF, Wu JC, et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial. Lancet. 2002; 359:9–13.

12. Labenz J, Blum AL, Bolten WW, et al. Primary prevention of diclofenac associated ulcers and dyspepsia by omeprazole or triple therapy in Helicobacter pylori positive patients: a randomised, double blind, placebo controlled, clinical trial. Gut. 2002; 51:329–335.

13. Vergara M, Catalán M, Gisbert JP, Calvet X. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther. 2005; 21:1411–1418.

14. de Leest HT, Steen KS, Lems WF, et al. Eradication of Helicobacter pylori does not reduce the incidence of gastroduodenal ulcers in patients on long-term NSAID treatment: double-blind, randomized, placebo-controlled trial. Helicobacter. 2007; 12:477–485.

15. Lai KC, Lau CS, Ip WY, et al. Effect of treatment of Helicobacter pylori on the prevention of gastroduodenal ulcers in patients receiving long-term NSAIDs: a double-blind, placebo-controlled trial. Aliment Pharmacol Ther. 2003; 17:799–805.

16. Hawkey CJ, Tulassay Z, Szczepanski L, et al. Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention. Lancet. 1998; 352:1016–1021.

17. Chan FK, Chung SC, Suen BY, et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med. 2001; 344:967–973.

18. Leung WK, Bjarnason I, Wong VW, Sung JJ, Chan FK. Small bowel enteropathy associated with chronic low-dose aspirin therapy. Lancet. 2007; 369:614.

19. Fletcher EH, Johnston DE, Fisher CR, Koerner RJ, Newton JL, Gray CS. Systematic review: Helicobacter pylori and the risk of upper gastrointestinal bleeding risk in patients taking aspirin. Aliment Pharmacol Ther. 2010; 32:831–839.

20. Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sáinz R. Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther. 2002; 16:779–786.

21. Chan FK, Ching JY, Suen BY, Tse YK, Wu JC, Sung JJ. Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology. 2013; 144:528–535.

22. McCarthy DM. Adverse effects of proton pump inhibitor drugs: clues and conclusions. Curr Opin Gastroenterol. 2010; 26:624–631.

23. Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010; 8:504–508.

24. Chan FK. Proton-pump inhibitors in peptic ulcer disease. Lancet. 2008; 372:1198–1200.

25. Chan FK, Lanas A, Scheiman J, Berger MF, Nguyen H, Goldstein JL. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet. 2010; 376:173–179.

26. Hagiwara T, Mukaisho K, Nakayama T, Sugihara H, Hattori T. Longterm proton pump inhibitor administration worsens atrophic corpus gastritis and promotes adenocarcinoma development in Mongolian gerbils infected with Helicobacter pylori. Gut. 2011; 60:624–630.

27. Wang X, Tian HJ, Yang HK, Wanyan P, Peng YJ. Meta-analysis: cy-clooxygenase-2 inhibitors are no better than nonselective non-steroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. Eur J Gastroenterol Hepatol. 2011; 23:876–880.

28. Goldstein JL, Chan FK, Lanas A, et al. Haemoglobin decreases in NSAID users over time: an analysis of two large outcome trials. Aliment Pharmacol Ther. 2011; 34:808–816.

29. Liu CP, Chen WC, Lai KH, et al. Formosa Acid-Related Disease (FARD) Study Group. Esomeprazole alone compared with esomeprazole plus aspirin for the treatment of aspirin-related peptic ulcers. Am J Gastroenterol. 2012; 107:1022–1029.

30. Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med. 2005; 352:238–244.

31. Almadi MA, Barkun A, Brophy J. Antiplatelet and anticoagulant therapy in patients with gastrointestinal bleeding: an 86-year-old woman with peptic ulcer disease. JAMA. 2011; 306:2367–2374.