Does eradication of Helicobacter pylori impair healing of nonsteroidal anti‐inflammatory drug associated bleeding peptic ulcers? A prospective randomized study

Abstract

Background: Despite the widely accepted view that Helicobacter pylori is the most important cause of peptic ulcer disease, recent studies have suggested that the microbe protects against nonsteroidal anti‐inflammatory drug (NSAID)‐associated gastroduodenal lesions and promotes ulcer healing. We investigated the effects of H. pylori eradication on the healing of NSAID‐associated bleeding peptic ulcers. Methods: Chronic NSAID users presenting with peptic ulcer haemorrhage underwent endoscopy to secure haemostasis and to document H. pylori infection by rapid urease test and culture. They were prospectively randomized to receive either omeprazole (20 mg once daily) for 8 weeks or a 1‐week course of triple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg, metronidazole 400 mg, all given four times daily) plus omeprazole (20 mg once daily) for 8 weeks. Endoscopy was repeated after 8 weeks. Final H. pylori status was determined by a 13C‐urea breath test that was performed at least 4 weeks after discontinuation of omeprazole. Results: 195 H. pylori‐infected NSAID users, complicated by bleeding ulcers, were randomized to receive omeprazole alone (102) or triple therapy plus omeprazole (93). 174 patients returned for second endoscopy at 8 weeks (91 in the omeprazole group, 83 in the triple therapy group). Urea breath test was negative in 14% in the omeprazole group vs. 92% in the triple therapy group (P < 0.001). Complete ulcer healing was achieved in 88 (97%) patients in the omeprazole group and 77 (93%) in the triple therapy group (P = 0.31). On intention‐to‐treat analysis, ulcers were healed in 86% of the omeprazole group and 83% of the triple therapy group (P = 0.50). There was no significant difference in the healing rates of gastric or duodenal ulcers between the two groups. Conclusion: Eradication of H. pylori did not impair the healing of NSAID‐associated bleeding peptic ulcers.

Nonsteroidal anti-inflammatory drug use does not affect short-term endoscopic and histologic outcomes after Helicobacter pylori eradication in patients with rheumatoid arthritis

“…6 Several controversies regarding H. pylori eradication in patients using NSAIDs still prevail. [7][8][9][10][11][12][13][14] Whether to attempt H. pylori eradication in patients receiving long-term treatment with NSAIDs remains controversial. Some reports advocate H. pylori eradication before NSAID therapy in order to reduce NSAID-induced peptic ulcer.…”

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

“…To confi rm the interaction between the two factors, it is necessary to conduct an interventional study determining the effects of H. pylori eradication on ulcer healing, but no conclusive evidence has been presented. [2][3][4] Although levels of gastric acid secretion have increased among Japanese, they are still lower when compared with those of Westerners. Sakamoto et al 7 reported a case-control study on the association of upper gastrointestinal bleeding and NSAIDs in Japan.…”

“…BianchiPorro et al 2 administered 40 mg/day omeprazole to H. pylori(−) patients with gastric ulcers, H. pylori(+) patients with gastric ulcers, and H. pylori-eradicated patients with gastric ulcers, and documented no significant differences in healing rates among the three groups: 4-week healing rates were 68%, 66%, and 68%, respectively, and 8-week healing rates were 76%, 90%, and 76%, respectively. Chan et al 3 divided H. pylori(+) patients with gastric ulcers into those with H. pylori infection and those in whom H. pylori was eradicated, and reported that, with 20 mg/day omeprazole, the 8- week healing rate for the two groups was 84% and 72%, respectively. Although the healing rate for the H. pylorieradicated patients was slightly lower, there was no signifi cant difference.…”

“…It is necessary to conduct an interventional study determining the effects of H. pylori eradication on ulcer healing, but no conclusive evidence has been presented. [2][3][4] Almost all studies examined by the meta-analysis were conducted in Western countries. Although levels of gastric acid secretion have increased among Japanese, they are still lower when compared with those of Westerners.…”

Helicobacter pylori and nonsteroidal anti-inflammatory drugs. Approaching the end of the controversy in the new millennium, or room for more debate?

“…Chan et al 65 performed a large prospective randomized study of ulcer healing in 195 H. pylori-infected patients who presented with ulcer hemorrhage. Patients were treated with 8 weeks of omeprazole and 1 week of triple therapy (bismuth, tetracycline, and metronidazole eradication therapy) or placebo.…”