Eradication of H pylori in chronic NSAID users: don't bother

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Eradication of H pylori in chronic NSAID users: don't bother

June 14, 2004 Zosia Chustecka

Rheumawire

Berlin, Germany - A yearlong study of 347 patients who were already

long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs) has

found no benefit in eradicating the bacteria Helicobacter pylori in the

gut and some adverse effects. " My advice to physicians dealing with

patients who are already chronic users of NSAIDs is that it not useful

to search for and treat H pylori infection in this population, " a

researcher involved in the study, Dr Willem Lems (VU Medical Center,

Amsterdam), tells rheumawire. [1]

" The story may be different for patients who are starting on

nonsteroidal anti-inflammatory drugs for the first timefrom the

literature, it appears that in these patients, it is useful to identify

and eradicate Helicobacter pylori before starting treatment, but I have

some questions about doing this in clinical practice, " he says, " because

it means delaying anti-inflammatory treatment in patients who are in

pain. "

The study, presented at the EULAR 2004 meeting, involved 347 patients

(61% female, mean age 59 years, 57% white) recruited from 8 outpatient

clinics in the Netherlands. All the patients had tested positive on an

ELISA blood test for H pylori infection, and all were long-term users of

NSAIDs. The most commonly used drugs were diclofenac (29%), naproxen

(18%), and ibuprofen (13%), and 9% of patients were taking selective

coxib agents. Nearly half of the patients (48%) were also taking

gastroprotective medication, and 37% of patients had a history of ulcer

disease.

Patients were randomized to receive either placebo or H pylori

eradication therapy with omeprazole 20 mg, amoxicillin 1000 mg, and

clarithromycin 500 mg twice daily for 7 days and were followed for 12

months. Endoscopy at 3 months showed a nonsignificant difference between

the 2 groups in the incidence of gastroduodenal ulcers.

During the 12-month follow-up, there were no symptomatic ulcers, ulcer

bleedings, or ulcer perforations in either group, and there were no

significant differences between the 2 groups in the development of

gastroduodenal erosions, dyspepsia, or quality of life.

However, the proportion of patients who experienced an adverse reaction

possibly related to the study medication (including diarrhea, nausea,

and stomatitis) was significantly higher in patients in the eradication

group than in the placebo group, 20% vs 2% (p<0.001). These results made

a planned cost analysis unnecessary, the researchers commented.

" Screening for and eradication of H pylori infection in this population

of chronic NSAID users had no beneficial effect at all and were

associated with more frequent adverse effects than placebo, " Lems told

rheumawire. Hence, his advice is " don't bother. "

Source

De Leest H, Steen KSS, Lems WF, et al. Eradication of

Helicobacter pylori dose not reduce the incidence of gastroduodenal

ulcers in patients on long-term NSAID treatment: a randomized

double-blind placebo-controlled trial. Presented at: EULAR 2004; Berlin,

Germany; June 9-12, 2004. Abstract FRI0005.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org