Helicobacter pylori and NSAID-induced gastric ulcer in a Japanese population

J Gastroenterol. 2009;44 Suppl 19:40-3. doi: 10.1007/s00535-008-2259-5. Epub 2009 Jan 16.

Abstract

A recent meta-analysis by Huang et al. clarified that Helicobacter pylori infection and nonsteroidal antiinflammatory drugs (NSAIDs) are important factors for peptic ulcer. The results showed that the risk for ulcer in NSAID(+)/H. pylori(+) patients was 61.1 fold higher when compared with NSAID(-)/H. pylori(-) patients. Some gastric ulcers detected in patients on NSAID therapy may actually be caused by H. pylori, but it is difficult to differentiate NSAID-induced gastric ulcer from H. pylori-induced gastric ulcer. Several studies have investigated the effects of H. pylori eradication on ulcer healing. One study reported that H. pylori eradication actually lowered the healing rate of gastric ulcers. Because there have been no studies finding that H. pylori eradication facilitates healing, H. pylori eradication is not recommended for NSAID users. Concerning the efficacy of H. pylori eradication in the prevention of NSAID-induced gastric ulcer, a meta-analysis concluded that among all patients on NSAID therapy, H. pylori eradication lowered the prevalence of ulcer, which was particularly marked in NSAID-naïve patients. When compared with those of proton pump inhibitors (PPIs), the preventative effects of H. pylori eradication were inferior. In Japan, national health insurance does not cover procedures that prevent or lower the risk for NSAID-induced ulcer. When administering NSAID to patients with risk factors, it is desirable to administer antiulcer agents.

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Asian Continental Ancestry Group
  • Clinical Trials as Topic
  • Helicobacter Infections / complications*
  • Helicobacter Infections / drug therapy
  • Helicobacter pylori / drug effects
  • Helicobacter pylori / isolation & purification
  • Humans
  • Insurance Coverage / economics
  • Japan / epidemiology
  • National Health Programs / economics
  • Proton Pump Inhibitors / therapeutic use
  • Stomach Ulcer / chemically induced*
  • Stomach Ulcer / drug therapy
  • Stomach Ulcer / microbiology

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Proton Pump Inhibitors