Interaction between Helicobacter pylori and non-steroidal anti-inflammatory drugs in peptic ulcer bleeding

Background: Helicobacter pylori and non-steroidal anti-inflammatory drugs ( NSAIDs) are the two primary causes of peptic ulcer disease. How H. pylori a nd NSAIDs interact and influence the development of ulcer bleeding is still not clear. Methods: A hospital-based, age- and sex-matched case-control st udy was conducted. Multivariate and stratified analyses were performed for further evaluation of the interaction between H. pylori and NSAIDs. Results : Ninety-seven patients (52 gastric ulcers, 45 duodenal ulcers) and 97 non- ulcer controls were enrolled in the study. H. pylori and NSAIDs were both f ound to be independent risk factors for ulcer bleeding (H. pylori odds rati o, 2.22; 95% confidence interval (CI), 1.23-4.01; NSAIDs odds ratio, 4.57; 95% CI, 2.50-8.35). There was no synergistic effect. In contrast, a negativ e interaction was observed in the logistic regression and stratified analys is, although the difference was not significant (H. pylori adjusted odds ra tio, 3.47; 95% CI, 1.73-6.95; NSAID adjusted odds ratio, 6.16; 95% CI, 3.14 -12.09). Conclusion: H. pylori increases the risk of peptic ulcer bleeding but may play a protective role in NSAID users.