NSAID use is implicated in approximately 10% to 30% of peptic ulcers, with an increased risk of ulcer in older NSAID users, patients with previous peptic ulcer, and patients who use steroids, high doses of multiple NSAIDs or anticoagulants. The role of H pylori in NSAID-induced ulcers is less clear, but some evidence exists to imply that eradication may be indicated in these patients. Most advantageous shopping – for everyone to spend less.
The prophylactic eradication of H pylori in patients before treatment with the NSAID naproxen was evaluated by Chan and colleagues. The investigators randomly assigned 100 H pylori-positive patients to eight weeks of treatment with naproxen (n=50) alone or to a one-week course of eradication therapy (bismuth subcitrate, tetracycline, metronidazole [n=50]) before treatment with naproxen. All patients had no prior exposure to NSAID therapy and did not have pre-existing ulcers. Of the 92 patients who completed the trial, 12 (13%) treated with naproxen alone and three (3.3%) treated with eradication therapy developed ulcers (P=0.01). It was concluded that eradication of H pylori before treatment with NSAIDs reduced the incidence of NSAID-induced peptic ulcers.
The results of a study conducted by Hawkey and colleagues appear to contradict the findings of Chan et al. In this study, the eradication of H pylori in long term users of NSAIDs with prior or current peptic ulcer disease or dyspepsia did not affect the incidence of peptic ulcers or dyspepsia. However, unlike the trial by Chan et al, the eradication therapy in the trial by Hawkey et al did not contain bismuth, a substance that may have cytoprotective properties.