HELICOBACTER-PYLORI ERADICATION MAY REDUCE THE RISK OF GASTRODUODENALLESIONS IN CHRONIC NSAID USERS

Helicobacter pylori and non-steroidal anti-inflammatory drugs are two Of the most common causes of peptic ulceration. The aim of this review is to assess the possible inter-relationships between Helicobacter py lori and non-steroidal anti-inflammatory drugs in the pathogenesis of gastric and duodenal erosions and ulcers, with the aim of assessing if the presence of Helicobacter pylori is likely to increase the likelih ood of non-steroidal anti-inflammatory drug-related gastroduodenal sym ptoms and lesions, and if eradication of Helicobacter pylori may reduc e or prevent non-steroidal anti-inflammatory drug lesions. There appea rs to be more likelihood of dyspeptic symptoms in patients on long-ter m nonsteroidal anti-inflammatory drugs when Helicobacter pylori is pre sent. The balance of evidence also suggests that peptic ulcers and ero sions in patients on long-term non-steroidal anti-inflammatory drugs m ay be more likely to occur in patients who are Helicobacter pylori pos itive compared to those who are Helicobacter pylori negative, Although Helicobacter pylori and non-steroidal anti-inflammatory drugs both in crease the risk of peptic ulcer bleeding, the risk does not appear to be additive. There is increasing evidence from prospective studies tha t eradication of Helicobacter pylori may reduce the incidence of ulcer s in patients on nonsteroidal anti-inflammatory drugs. More prospectiv e long-term studies are required. If Helicobacter pylori is confirmed to be a factor in this respect, it will aid in the targeting of patien ts at greatest risk of developing ulcers in patients on long-term non- steroidal anti-inflammatory drugs. Those at greatest risk are elderly patients, especially females, smokers, patients with a previous ulcer history, severe or debilitating arthritis or who have other chronic di seases. The addition of Helicobacter pylori to this list and its subse quent eradication may improve the outlook for these patients and help in the effective targeting of patients at greatest risk who are on lon g-term non-steroidal anti-inflammatory drugs.