H. pylori Infection Increases Upper GI Bleeding Risk in NSAID Users

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H. pylori Infection Increases Upper GI Bleeding Risk in NSAID Users

By Will Boggs, MD

NEW YORK (Reuters Health) May 25 - The presence of Helicobacter pylori

infection is associated with a significantly higher risk of upper

gastrointestinal bleeding among nonsteroidal anti-inflammatory drug (NSAID)

users, according to a report in the May 1st issue of The American Journal of

Medicine.

H. pylori infection is the most common cause of peptic ulcer disease in

patients not taking NSAIDs, the authors explain, but the risk of peptic

ulcer and its complications in patients with H. pylori and taking NSAIDs is

uncertain.

Dr. V. Papatheodoridis from Hippokration General Hospital of Athens,

Greece, and colleagues investigated whether infection with H. pylori,

including specific cytotoxic-associated antigen (CagA)-positive strains,

increased the risk of upper gastrointestinal bleeding in patients using

NSAIDs.

Cases admitted with upper GI bleeding were compared with outpatients without

bleeding, although both groups were users of NSAIDs.

The cases and controls did not differ in smoking habits, alcohol

consumption, recent corticosteroid use, use of anticoagulants, or comorbid

diseases, the report indicates, and there were no significant differences

between the groups in CagA positivity.

H. pylori was detected in more cases (79%) than controls (56%), the authors

report.

In a multivariate logistic regression analysis, H. pylori was independently

associated with a significant increase in the odds of upper gastrointestinal

bleeding. A history of peptic ulcer disease and a short duration of NSAID

use were more common among case patients, but these differences did not

reach statistical significance.

" We confirmed that H. pylori is an independent risk factor (approximately

two-fold increase) for upper GI bleeding in NSAIDs/aspirin users in a

well-designed, prospective, controlled study, " Dr. Papatheodoridis told

Reuters Health.

" Both H. pylori and NSAID use are independent risk factors for upper GI

bleeding, " Dr. Papatheodoridis said. " We cannot determine which factor

contributes more. "

" In clinical practice, " Dr. Papatheodoridis commented, " I test the H. pylori

status, and, if positive, treat H. Pylori infection in all new (naive)

NSAIDs/aspirin users and in chronic NSAIDs/aspirin users who have other risk

factors for upper GI bleeding (history of peptic ulcer or its complications,

age older than 65, anticoagulation therapy). "

Am Med J 2004;116:601-605.