Review article: Helicobacter pylori and NSAID gastropathy

Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori are known to share a number of pathogenic mechanisms, but there is no evidence to show a significant synergic action between the two risk factors, Studies assessing this subject have differed in almost every aspect of their metho dology, including the definition of a NSAID user as well as the types, dose s, duration and their indications for NSAID use. They also differed in thei r end-points, the definition of dyspepsia and the regimes used for eradicat ion of a pylori. However, some conclusions may be drawn from the results of clinical trials. In H. pylori-positive patients without mucosal lesions, NSAIDs may aggravat e dyspeptic symptoms but, with the exception of elderly patients, they do n ot present a definite major risk of gastric and duodenal lesions and, above all, of ulcer-correlated complications. So what recommendations can be made with regard to H. pylori eradication in patients requiring treatment with NSAIDs? The microorganism and the anti-i nflammatory drugs are undoubtely independent causes of gastric and duodenal damage. Patients taking NSAIDs who are found to have gastric or duodenal u lcers should therefore be tested for the bacterium and specifically treated , since H. pylori and NSAID-induced ulcers may be macroscopically indisting uishable. Whether asymptomatic patients taking NSAIDs should be tested and treated fo r H. pylori infection is still a matter of debate.