Neutrophils, Helicobacter pylori, and nonsteroidal anti-inflammatory drug ulcers

Background & Aims: Gastric injury by nonsteroidal antiinflammatory drugs (N SAIDs) is minimal in neutropenic animals. This study examined peptic ulcer development in the presence or absence of gastric neutrophils in patients r equiring long-term use of NSAIDs. Methods: Gastric histology, neutrophils, and Helicobacter pylori were assessed in 120 patients randomized to receive placebo or 20 or 40 mg famotidine twice daily as prophylaxis against NSAID -related ulcers and who underwent endoscopy at 0, 4, 12, and 24 weeks. Resu lts: In 43 patients without gastric neutrophils, ulcers developed in 1 of 1 4 (7.7%) taking placebo, 2 of 16 (12.5%) taking 20 mg famotidine, and none of 13 taking 40 mg famotidine. However, in 77 patients with neutrophils, ul cers developed in 13 of 28 (47.4%) taking placebo (P < 0.001), 3 of 26 (12. 6%) taking 20 mg famotidine, and 3 of 23 (13%) taking 40 mg famotidine. Eig ht of 46 patients (17%) without H. pylori had neutrophils compared with 69 of 74 (93%) with both H. pylori and neutrophils (P < 0.001). Conclusions: G astric neutrophils increase the incidence of ulceration in long-term NSAID users. Because neutrophils exist with H. pylori, eradicating this infection might prevent NSAID-related peptic ulcers.