SEVERE GASTRIC-MUCOSAL DAMAGE-INDUCED BY NSAIDS IN HEALTHY-SUBJECTS IS ASSOCIATED WITH HELICOBACTER-PYLORI INFECTION AND HIGH-LEVELS OF SERUM PEPSINOGENS
L. Santucci et al., SEVERE GASTRIC-MUCOSAL DAMAGE-INDUCED BY NSAIDS IN HEALTHY-SUBJECTS IS ASSOCIATED WITH HELICOBACTER-PYLORI INFECTION AND HIGH-LEVELS OF SERUM PEPSINOGENS, Digestive diseases and sciences, 40(9), 1995, pp. 2074-2080
Helicobacter pylori infection and NSAIDs are considered the two most i
mportant exogenous factors in ulcer disease. The interrelation between
the two factors is not, however, clear. Moreover, serum pepsinogen ha
s been suggested as a risk marker for the development of NSAID-induced
gastrointestinal lesions. Fifty-one healthy volunteers, enrolled in a
prospective, double-blind study carried out to evaluate gastrointesti
nal side effects of meloxicam and piroxicam, were analyzed to determin
e whether: (1) the prevalence of H. pylori correlates with the occurre
nce and severity of NSAID-induced gastrointestinal lesions, and (2) se
rum pepsinogen A and C levels could be used as markers of NSAID-induce
d mucosal damage. Upper endoscopy was performed by the same investigat
or before and after 28 days of treatment with placebo, meloxicam (7.5
mg/day and 15 mg/day), or piroxicam (20 mg/day). NSAID-induced damage
was graded separately for hemorrhages and erosion ulcers according to
Lanza's scale. There were no statistically significant differences in
the prevalence of H. pylori in subjects with and without NSAID-induced
mucosal lesions. However, there was a positive association between H.
pylori infection and the severity of mucosal damage: total mean endos
copic score was 2.9 +/- 0.3 in H. pylori-positive subjects versus 1.6
+/- 0.5 in H. pylori-negative subjects (P < 0.05). Pepsinogen A and C
levels increased from 55.3 +/- 3 to 149.4 +/- 15 and from 6.3 +/- 0.5
to 11.5 +/- 2.2, respectively (P < 0.05) in subjects who developed sev
ere endoscopic injury. It is concluded that H. pylori increases the se
verity of NSAID-induced gastrotoxicity and that pepsinogen A and C lev
els are valid markers of severe NSAID-induced mucosal lesions.