Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidalanti-inflammatory drugs: A case-control study

Background & Aims: Peptic ulcer complications related to use of nonsteroida l anti-inflammatory drugs (NSAIDs) are among the most common serious advers e drug reactions, Whether Helicobacter pylori infection potentiates this ga strointestinal toxicity of NSAIDs is still unresolved. In this study, we in vestigated the role of H. pylori as a cause of bleeding peptic ulcer among NSAID users. Methods: A case-control study of current users (n = 132) of NS AIDs (including acetylsalicylic acid), admitted because of bleeding peptic ulcer, was performed. Controls were 136 NSAID users without gastrointestina l complications. H. pylori was diagnosed by either increased levels of seru m immunoglobulin G or by C-13-urea breath test. Results: Fifty-eight (44%) case subjects had a bleeding gastric ulcer, 54 (41%) had a bleeding duodena l ulcer, 12 (9%) had both gastric and duodenal ulcers, and 8 (6%) had hemor rhagic gastritis. H. pylori was present in 75 (51%) cases compared with 59 (43%) controls. The adjusted odds ratio of bleeding peptic ulcer among NSAI D users associated with H. pylori infection was 1.81 (95% confidence interv al, 1.02-3.21). H. pylori accounted for approximately 24% of bleeding pepti c ulcers among elderly NSAID users. Conclusions: NSAID users infected with H. pylori have an almost twofold increased risk of bleeding peptic ulcer co mpared with NSAID users without H, pylori.