ULCER SITE AND COMPLICATIONS - RELATION TO HELICOBACTER-PYLORI INFECTION AND NSAID USE

Background and Study Aim: The aim of this study was to investigate the relationship between the presence and location of ulcers, H. pylori i nfection, NSAID use, and major upper gastrointestinal tract bleeding, Patients and Methods: We studied 100 consecutive patients with duodena l ulcers and 145 consecutive patients with benign gastric ulcers, Resu lts: Ninety-nine percent of the duodenal ulcer patients and 92% of the gastric ulcer patients had H. pylori infection; all gastric ulcer pat ients without H. pylori infection were using NSAIDs, Gastric ulcers in patients with H. pylori infection who were not using NSAIDs were more likely to be on the lesser curvature (85%) than ulcers in NSAID users who had no H. pylori infection (36%) (p < 0.01). Conversely, only 5% of gastric ulcers in H. pylori-positive patients who were not using NS AIDs were on the greater curvature, compared to 45% in H. pylori-negat ive NSAID users (p < 0.01), and 23% in patients with both possible eti ologies, The frequency of NSAID use was very high in patients presenti ng with upper gastrointestinal tract bleeding: 21 of 25 with gastric u lcers (84%) and 13 of 21 with duodenal ulcers (62%; p < 0.01 for each, compared to bleeding without taking NSAIDs), Overall, 74% of patients with upper gastrointestinal hemorrhage from peptic ulcer were taking NSAIDs, The prevalence of H. pylori infection was similar among the ul cer patients presenting with and without upper gastrointestinal tract bleeding, Conclusions: The location of a gastric ulcer on the greater curvature, and presentation with upper gastrointestinal tract bleeding , are separate and valuable clues to the involvement of NSAIDs, NSAID use may now be responsible for most bleeding complications of ulcer di sease, regardless of H. pylori status.