Non-steroidal anti-inflammatory drugs, Helicobacter pylori and bleeding gastric ulcer

Background: Helicobacter pylori infection and NSAID usage are considered to be independent risk factors for gastric ulcer (GU). Whether they interact to influence the risk of bleeding in GU is unclear. Aim: To determine the prevalence of H. pylori infection and NSAID ingestion in a group of patients with GU and determine their roles in bleeding and n on-bleeding GU. Methods and results: From January 1993 to June 1996, a total of 217 GU pati ents (150 male, 67 female, median age 61 years, range 26-94) were eligible for the study. Eighty-five per cent were H. pylori-positive and 15% were H. pylori-negative. NSAID usage within 4 weeks prior to endoscopy was present in 30%, more in the H. pylori-negative than H. pylori-positive patients (5 9% vs. 25% P = 0.0002). Aspirin was most commonly used (43%). One hundred p atients bled from GU (69 male, 31 female, mean age 67 years, range 26-94) a nd 117 did not (81 male, 36 female, mean age 57 years, range 28-86). Univar iate logistic regression showed that advanced age (greater than or equal to 65 years) and NSAID usage carried an increased risk of bleeding GU (odds r atio 3.4 and 6.8, respectively) while H. pylori infection alone was not ass ociated with additional risk (OR = 0.8). However, when three variables were considered jointly in a multiple logistic regression, the OR associated wi th H. pylori infection increased to 2.4, suggesting that in the presence of NSAIDs and advanced age, H. pylori also increases the risk of bleeding GU, indicating an interaction between the variables. Conclusion: NSAID usage and advanced age are risk factors for bleeding GU, whereas H. pylori infection by itself is not. In the presence of NSAIDs and advanced age, an increased risk of bleeding GU with H. pylori is observed, indicating the possibility of an interaction between these factors.