Effect of treatment of <scp>Helicobacter pylori</scp> on the prevention of gastroduodenal ulcers in patients receiving long‐term NSAIDs: a double‐blind, placebo‐controlled trial

Lai, KC; Lau, CS; Ip, Wan‐Yim; Wong, Benjamin C.Y.; Hui, W. M.; Hu, Whc; Wong, R. W. M.; Lam, SK

doi:10.1046/j.1365-2036.2003.01528.x

Cited by 63 publications

(49 citation statements)

References 21 publications

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“…Eradication of H. pylori infection before starting NSAID therapy may be the single most cost-eff ective strategy for the primary prevention of NSAID-associated ulcers in adult patients ( 67 ). Th e benefi t of H. pylori eradication in patients already taking NSAIDs is less clear ( 68 ). RCTs suggest that H. pylori eradication does not reduce the incidence of new peptic ulcers in chronic NSAID users ( 69 ) and that PPI therapy provides a more eff ective ulcer risk reduction strategy than H. pylori eradication in patients on chronic NSAIDs ( 66 ).…”

Section: Non-steroidal Anti-infl Ammatory Drug (Nsaid) Usementioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,266

1,505

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Helicobacter pylori ( H. pylori ) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-infl ammatory medication, unexplained iron defi ciency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori , patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For fi rst-line treatment, clarithromycin triple therapy should be confi ned to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by fi rst-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When fi rst-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a fi rst-line treatment containing clarithromycin, bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options. If a patient received fi rst-line bismuth quadruple therapy, clarithromycin or levofl oxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested fi rst-line and salvage regimens can be found in the guideline. Asia and Central and South America ( 8,22 ). Th ere is, however, preliminary evidence that it may be falling in some previously high prevalence areas ( 22 ). People immigrating to North America from Asia and other parts of the world have a much higher prevalence of the infection than people born in North America ( 23 ). In one study, the seroprevalence among immigrants from East Asia was 70.1% ( 24 ). Hispanic immigrants to North America have higher rates of the infection than fi rst-or second-generation Hispanics who were born here ( 25 ). QUESTION 2: WHAT ARE THE INDICATIONS TO TEST FOR, AND TO TREAT, H. PYLORI INFECTION? RecommendationsSince all patients with a positive test of active infection with H. pylori should be off ered treatment, the critical issue is which patients should be tested for the infection (strong recommendation, quality of evidence: not applicable), All patients with active peptic ulcer disease (PUD), a past history of PUD (unless previous cure of H. pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer (EGC) should be tested for H. pylori infection. Th ose who test positive should be off ered treatment for the infection (strong recommendation, quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC).In patients with uninvestigated d...

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Section: Non-steroidal Anti-infl Ammatory Drug (Nsaid) Usementioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,266

1,505

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“…9 Several other reports also indicated that H. pylori eradication should be avoided from a standpoint of prevention, healing, and recurrence of UGI ulcers for arthritis patients. 7,13,14 The difference in the methodology and study design may help to explain the contrasting results among these studies according to several reviews. 6,31,32 Since there are few reports on the effect of NSAIDs on endoscopic and histological fi ndings before and after H. pylori eradication, we compared these fi ndings before and after the treatment of eradication between successful and unsuccessful eradication groups of NSAID users with RA.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2007

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We evaluated the effects of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) on endoscopic and histological findings in patients with rheumatoid arthritis (RA) before and after the eradication of Helicobacter pylori infection. Helicobacter pylori (H. pylori) eradication using lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 mg twice daily for 1 week was conducted in 44 patients (mean age: 56.5 years) with RA. Using the updated Sydney system, endoscopic and histological findings of the greater curvature of the antrum, the greater curvature of the upper corpus, and the lesser curvature of the lower corpus were compared before and after eradication, for a mean follow-up period of 3.5 months. Overall, H. pylori eradication was successful in 32 patients (72.7%). Of these 32 patients, 23 were NSAID users. In the successful eradication group, (1) there was no significant change on endoscopic findings, including gastric erythema and erosion in all three regions irrespective of NSAIDs use; (2) of 17 active ulcers before eradication in NSAIDs users, all healed except for one duodenal ulcer that persisted, where one patient newly developed a gastric ulcer, one developed erosive duodenitis, and two developed reflux esophagitis, all in NSAID users; (3) neutrophil infiltration and chronic inflammation were significantly improved in all three regions after H. pylori eradication irrespective of use of NSAIDs, while atrophic change and intestinal metaplasia did not change. In the eradication failure group; (1) there was no significant change on endoscopic and histological findings in the three regions; (2) two of three ulcers present before eradication on NSAID users persisted even after eradication, and no new cases of gastric ulcer or erosive duodenitis occurred. In conclusion, over a mean follow-up period of 3.5 months, use of NSAIDs in Japanese patients with RA did not impair the healing process of gastric and duodenal ulcers nor did it affect the endoscopic and histological improvements associated with H. pylori eradication.

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“…Respondents were asked whether they would offer testing for H. pylori in different clinical scenarios, according to previous studies [13, 17, 23]. Owing to recent advances [3,24,25,26,27,28], questions on aspirin prophylaxis were added. Respondents’ specialty, mode of practice (public or private), experience of practice (year after graduation) and professional achievement (specialist qualification) were collected.…”

Section: Methodsmentioning

confidence: 99%

Factors Affecting Physicians’ Practices Related to <i>Helicobacter pylori</i> Infection: Effect of Experience and Mode of Practice

Yee¹,

Cheung²,

Gu³

et al. 2008

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Background: Studies found that guidelines on the management of Helicobacter pylori were not always followed in clinical practice. This study investigated factors that were responsible for the deviation. Methods: A cross-sectional survey using a structured self-administered questionnaire was used to ask physicians whether they would offer testing and treatment for H. pylori infection in different clinical scenarios. Results: 170 medical practitioners completed the questionnaires. Respondents in the private sector were significantly more likely to test and treat than those in the public sector for patients with a history of peptic ulcer, gastric cancer or no symptom (p = 0.018, <0.001 and 0.041, respectively). Significant differences in practice were noted amongst practitioners of different specialty and seniority, but not qualification. Medical practitioners in the private sector complied with the guidelines significantly better than those in the public sector (p = 0.002) and so did senior practitioners compared with junior practitioners (p < 0.001). The specialty and qualification of the respondents, however, did not have a significant effect. Conclusion: There were significant differences in the management of H. pylori amongst medical practitioners from the private and public sectors and amongst senior and junior practitioners. Published guidelines were not completely followed. Further educational campaigns are needed.

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Effect of treatment of Helicobacter pylori on the prevention of gastroduodenal ulcers in patients receiving long‐term NSAIDs: a double‐blind, placebo‐controlled trial

Cited by 63 publications

References 21 publications

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

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

Factors Affecting Physicians’ Practices Related to <i>Helicobacter pylori</i> Infection: Effect of Experience and Mode of Practice

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