Should We Eradicate Helicobacter pylori Before Prescribing an NSAID? Result of a Placebo-Controlled Study

Schaeverbeke, Thierry; Broutet, Nathalie; Zerbib, F.; Combe, Bernard; Bertin, Philippe; Lamouliatte, H; Perie, F.; Joubert-Collin, M.; Mégraud, F

doi:10.1111/j.1572-0241.2005.00302.x

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…The interaction between H. pylori infection and NSAIDs in the pathogenesis of PUD remains controversial. Studies attempting to clarify this interaction have yielded conflicting results (39)(40)(41)(42)(43)(44). The discordant results can, in part, be explained by differences in study methodology, outcome measures, definitions of ulcer, and patient populations.…”

Section: Persons Using Nonsteroidal Antiinflammatory Drugs (Nsaids) or Aspirinmentioning

confidence: 99%

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection

Chey

2007

Am J Gastroenterology

1,220

1,040

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Helicobacter pylori (H. pylori) remains a prevalent, worldwide, chronic infection. Though the prevalence of this infection appears to be decreasing in many parts of the world, H. pylori remains an important factor linked to the development of peptic ulcer disease, gastric malignanc and dyspeptic symptoms. Whether to test for H. pylori in patients with functional dyspepsia, gastroesophageal reflux disease (GERD), patients taking nonsteroidal antiinflammatory drugs, with iron deficiency anemia, or who are at greater risk of developing gastric cancer remains controversial. H. pylori can be diagnosed by endoscopic or nonendoscopic methods. A variety of factors including the need for endoscopy, pretest probability of infection, local availability, and an understanding of the performance characteristics and cost of the individual tests influences choice of evaluation in a given patient. Testing to prove eradication should be performed in patients who receive treatment of H. pylori for peptic ulcer disease, individuals with persistent dyspeptic symptoms despite the test-and-treat strategy, those with H. pylori-associated MALT lymphoma, and individuals who have undergone resection of early gastric cancer. Recent studies suggest that eradication rates achieved by first-line treatment with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin have decreased to 70-85%, in part due to increasing clarithromycin resistance. Eradication rates may also be lower with 7 versus 14-day regimens. Bismuth-containing quadruple regimens for 7-14 days are another first-line treatment option. Sequential therapy for 10 days has shown promise in Europe but requires validation in North America. The most commonly used salvage regimen in patients with persistent H. pylori is bismuth quadruple therapy. Recent data suggest that a PPI, levofloxacin, and amoxicillin for 10 days is more effective and better tolerated than bismuth quadruple therapy for persistent H. pylori infection, though this needs to be validated in the United States.

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Section: Persons Using Nonsteroidal Antiinflammatory Drugs (Nsaids) or Aspirinmentioning

confidence: 99%

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection

Chey

2007

Am J Gastroenterology

1,220

1,040

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“…Subanalyses demonstrated that risk reduction was evident in NSAID-naive individuals, but not for those previously taking NSAIDs. 215,219 Iron-deficiency anaemia EHSG recommends H. Pylori testing and eradication in patients with unexplained iron deficiency anaemia. There is emerging evidence to suggest that eradication of H. Pylori can improve iron deficiency anaemia 216,217 , but the available data do not prove cause and effect.…”

Section: Persons Using Nsaids or Aspirinmentioning

confidence: 99%

Helicobacter Pylori Infection in Peptic Ulcer Disease

Tsang¹,

Shrestha²

2011

Peptic Ulcer Disease

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“…Schaeverbeke et al. [54] showed that the prevalence of gastrointestinal symptoms in rheumatoid patients infected with H. pylori and treated with a nonsteroidal anti‐inflammatory drug (NSAID) for 2 weeks exhibited similar gastrointestinal tolerance to NSAID irrespective of H. pylori infection; this suggests a lack of interaction between these two independent risk factors in the gastric mucosa. On the other hand, H. pylori increased the risk of duodenal ulcers in elderly individuals subjected to the treatment with vascular protective doses of aspirin [55].…”

Section: Interaction Between H Pylori and Physiologic And Pathophysimentioning

confidence: 99%

Pathogenesis of Helicobacter pylori Infection

Hatakeyama

Brzozowski

2006

Helicobacter

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Much interest has been shown in the relationship between Helicobacter pylori infection and gastric carcinogenesis. It is becoming clearer that H. pylori strains carrying a functional cag pathogenicity island (cagPAI), which encodes the type IV secretion system (TFSS) and its effector CagA, play an important role in the development of gastric carcinoma. Furthermore, genetic polymorphism present in the cagA gene appears to influence the degree of an individual cagPAI-positive H. pylori to elicit gastric mucosal lesions, and this process is significantly affected by host genetic polymorphisms such as proinflammatory cytokine gene polymorphisms. Pathomechanism of gastric carcinogenesis associated with H. pylori includes bacteria-host interaction leading to morphologic alterations such as atrophic gastritis and gastrointestinal metaplasia mediated by COX-2 overexpression, cancer cell invasion, and neo-angiogenesis via TLR2/TLR9 system and transcription factors (e.g., NF-kappaB) activation. In addition, H. pylori infection triggers adhesion molecule expression and activity and produces an enhancement in oxidative stress interacting with gastric production of appetite hormone ghrelin and nonsteroidal anti-inflammatory drugs.

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Should We Eradicate Helicobacter pylori Before Prescribing an NSAID? Result of a Placebo-Controlled Study

Abstract: The short-term (6 wks) GI tolerance of conventional NSAIDs does not differ whether or not the patients are infected by H. pylori. The tendency observed for the medium term (12 wks) deserves to be confirmed.

Cited by 8 publications

References 15 publications

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection

Helicobacter Pylori Infection in Peptic Ulcer Disease

Pathogenesis of Helicobacter pylori Infection

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