Peptic ulcer bleeding: Interaction between non-steroidal antiinflammatory drugs, Helicobacter pylori infection, and the ABO blood group system

Background: Helicobacter pylori infection is found in almost all patients w ith an uncomplicated ulcer. Non-steroidal anti-inflammatory drug (NSAID) us e is the main risk factor for bleeding peptic ulcer. in the older literatur e ABO blood groups were mentioned as a risk factor. There is continuing unc ertainty about the interaction between these risk factors and the developme nt of peptic ulcer bleeding. We therefore determined the separate and combi ned effect of NSAIDs, H. pylori infection, and the ABO blood group system i n patients with a bleeding peptic ulcer. Methods: The prevalence of NSAID u se, H. pylori infection, and blood group O was determined in 227 patients w ho were admitted with a bleeding gastric or duodenal ulcer between 1990 and 1997. These results were compared with the expected frequency of these ris k factors in the Dutch population. Results: NSAID use was reported in 48.2% of the patients with a bleeding peptic ulcer. The H. pylori prevalence was 62.0%, whereas blood group O was present in 49.3% of the patients. NSAID u se was the strongest risk factor for hemorrhage caused by a peptic ulcer (r elative risk, 8.4), whereas the relative risk associated with H. pylori inf ection and blood group O was 1.5 and 1.2, respectively. With univariate ana lysis NSAID use and H. pylori infection seemed to be separate risk factors and did not really potentiate each other's effect, Moreover, blood group O did not potentiate the strong effect of NSAIDs. Conclusion: H. pylori infec tion may add only a little to the important risk of NSAID use in the develo pment of bleeding peptic ulcers.