ULCER BLEEDING AND PERFORATION - NONSTEROIDAL ANTIINFLAMMATORY DRUGS OR HELICOBACTER-PYLORI

Non-steroidal anti-inflammatory drug (NSAID)-exposure increases the ri sk for ulcer perforation by a factor of 5-8. Recent data from Norway i ndicate that NSAID exposure is more common in gastric than in prepylor ic, pyloric and duodenal perforation. Twenty to 40% of patients with g astric perforation have used NSAIDs; attributable risks are not publis hed. The risk for ulcer bleeding is increased by a factor of 3-5 in NS AID users, with similar effects for stomach and duodenum. NSAID exposu re accounts for 20-35% of ulcer bleedings. There is little knowledge a bout the role of Helicobacter pylori in ulcer complications, a limited importance of the bacteria is indicated in the etiology of both perfo ration and bleeding. Ulcer complications have a multifactorial origin. NSAIDs account for a limited part of the events. H. pylori infection may play a still undocumented role. Smoking, alcohol and aspirin are o ther important causal factors.