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Use of NSAIDs and infection with Helicobacter pylori—what does the rheumatologist need to know?

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Kiltz, U and Zochling, J and Schmidt, WE and Braun, J (2008) Use of NSAIDs and infection with Helicobacter pylori—what does the rheumatologist need to know? Rheumatology, 47 (9). pp. 1342-1347. ISSN 1462-0332

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Abstract

Objectives. NSAID-induced gastroduodenal lesions are a frequent and potentially serious health problem in patients with rheumatic diseases. Helicobacter pylori (H. pylori ) has also been recognized as a major risk factor for the development of ulcer disease. However, the role of H. pylori in the pathogenesis of NSAID-induced gastroduodenal lesions has remained controversial, and there is currently no clear consensus on the management of NSAID users who are infected with H. pylori. Methods. To clarify this situation we have performed a systematic literature search to find randomized controlled trials comparing the efficacy of eradication in patients receiving NSAIDs to prevent ulcer development. Results. Seven randomized controlled trials and one meta-analysis were identified. There were three papers on NSAID-naive patients. According to this data, NSAID-naive users benefit from testing for H. pylori infection and subsequent H. pylori eradication therapy prior to the initiation of NSAID. In contrast, H. pylori eradication alone does not protect chronic NSAID users with recent ulcer complications from further gastrointestinal (GI) events. To prevent recurrent ulcer bleeding long-term acid suppressive therapy is needed. Conclusions. In conclusion, ulcer risk reduction after H. pylori eradication therapy is clearly more marked in patients beginning NSAID therapy than in patients who were already receiving and tolerating NSAID therapy. Thus, the management of H. pylori infection and the prevention of GI complications in NSAID users need to be individualized on the basis of recently published data.

Item Type: Article
Journal or Publication Title: Rheumatology
Page Range: pp. 1342-1347
ISSN: 1462-0332
Identification Number - DOI: 10.1093/rheumatology/ken123
Additional Information: The definitive publisher-authenticated version is available online at: www.oxfordjournals.org
Date Deposited: 01 Aug 2008 00:13
Last Modified: 18 Nov 2014 03:47
URI: http://eprints.utas.edu.au/id/eprint/7227
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