The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients infected with Helicobacter pylori increases the risk of stomach ulcers and bleeding.

These data were published in the January issue of Lancet. Dr. Richard H. Hunt and colleagues from the University of Hamilton Medical Center (Ontario, Canada) searched the literature for this problem and identified 25 studies of the prevalence of peptic ulcer with NSAIDs in patients infected with H. pylori and without infection.

In 16 trials involving 1,625 patients, the odds ratio for peptic ulcer was 2.12 in H. pylori positive patients taking NSAIDs compared to patients in whom H. pylori was not found.

In patients without Helicobacter pylori, taking NSAIDs, the odds ratio for peptic ulcer was 19.4 compared to the control group (healthy individuals).

In patients with Helicobacter pylori taking NSAIDs, the odds ratio for peptic ulcer compared to the control increased to 61.1.

In addition, the scientists identified 9 case-control studies with a total of 893 patients with ulcer bleeding and 1,002 patients in the control group. The odds ratio for developing bleeding as a complication of peptic ulcer in patients with H. pylori infection was found to be 1.79, in patients taking NSAIDs it was 4.85 and with a combination of these two risk factors the odds ratio for bleeding increased to 6.13.

In another article, Dr. Francis KL Chan and his colleagues from Hong Kong conducted a 6-month controlled study, involving patients with arthritis and H. pylori infection . The patients were randomized into 2 groups: the first eradication treatment was received: amoxicillin 1 g, clarithromycin 500 mg and omeprazole 20 mg (each drug was prescribed 2 times a day) for 1 week; the second (control) received 20 mg of omeprazole and a placebo twice a day for 1 week. Patients in both groups received a prescription for diclofenac delay 100 mg daily for 6 months.

During an endoscopic examination when observing patients after the end of treatment, it turned out that a peptic ulcer was diagnosed in 5 patients of the first group; in the placebo group, peptic ulcer was diagnosed in 15 people and in 3 patients, bleeding started and treatment was required.

Results indicate the need to examine and treat patients with helicobacterial infection before starting long-term treatment with NSAIDs to reduce the possible risk of developing peptic ulcer, as well as the appointment of H. pylori eradication therapy or the use of selective cyclooxygenase-2 (COX-2) inhibitors in patients in high-risk groups.