Influence of Helicobacter pylori Eradication Therapy on the Occurrence of GI Events in Patients Treated with Conventional NSAIDs Combined with Omeprazole

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Influence of Helicobacter pylori Eradication Therapy on the Occurrence

of Gastrointestinal Events in Patients Treated with Conventional

Nonsteroidal Antiinflammatory Drugs Combined with Omeprazole

BERNARD BANNWARTH, ETIENNE DORVAL, AGNES CAEKAERT, and PHILIPPE

BARTHELEMY

ABSTRACT.

Objective. To evaluate the effect of eradication treatment of

Helicobacter pylori and the influence of H. pylori status on the

incidence of gastrointestinal (GI) events in rheumatic patients

receiving longterm conventional nonsteroidal antiinflammatory drug

(NSAID) therapy combined with omeprazole.

Methods. Patients (n = 919) requiring longterm NSAID therapy entered

this multicenter, open label, parallel group study. H. pylori positive

patients were randomized to receive either eradication therapy

(omeprazole 20 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg

bid for 7 days) or no therapy. Both these groups and the H. pylori

negative patients were given omeprazole, 20 mg once daily, along with

NSAID for the study duration (5-8 weeks). Treatment failure (primary

outcome variable) was defined as the occurrence of severe GI event

(symptomatic ulcer, bleeding, perforation) or dyspepsia leading to

discontinuation of NSAID therapy, unscheduled consultation, or upper GI

tract endoscopy.

Results. Treatment failure was recorded in 9/294 (3.06%) infected

patients receiving eradication therapy, 8/219 (3.65%) infected patients

receiving omeprazole alone, and 5/391 (1.28%) H. pylori negative

patients (p > 0.05). H. pylori eradication did not appear to influence

the incidence and severity of dyspeptic symptoms in infected patients.

Conclusion. Our results do not support the use of H. pylori eradication

therapy in rheumatic patients receiving conventional NSAID along with

omeprazole. (J Rheumatol 2002;29:1975-80)