The Role of Helicobacter Pylori in NSAIDs Related Gastroduodenal Complications

Abstract

Background: Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs) are two major causes of gastroduodenal mocusal damages. The results of the epidemiological studies in relation to interaction between H. pylori and NSAIDs on the development of mocusal damages are conflicting. The present study was designed to determine the association of H. pylori and NSAIDs with peptic ulcers (PU) and gastrointestinal bleeding (GIB).

Materials and Methods: Patients with acute GIB and patients with dyspepsia who have referred for upper endoscopy were assessed with regard to history of using NSAIDs and H. pylori infection. In statistical analysis the frequency of gastroduodenal lesions and GIB were determined and compared. The association of peptic ulcers and GIB with H. pylori and NSAIDs was determined by calculation of odds ratio (OR).

Results: 104 patients with GIB and 102 dyspeptic patients with mean ages of 48±20 and 44±18 years respectively were studied. 51% of patients with GIB and 34 % of patients with dyspepsia were taking NSAIDs (P‹0.025). The risk of doudenal ulcer (DU) and bleeding in NSAIDs users was significantly higher than non-users (OR=4.3, P=0.021); and (OR=2.54, P=0.012) respectively. H. pylori infection was also associated with increased risk of DU compared with non-infected patients, (OR=23.33, P=0.000), but the risk of GU and bleeding in H. pylori infected patients was significantly lower than non-infected patients (OR=0.18, P=0.019). Presence of both H. pylori and NSAIDs significantly increased the risk of DU (OR=20.57, P‹0.000) but non-significantly decreased the risk of GU (OR=0.38, P‹0.193) without increasing the risk of GIB. H. pylori infection in NSAIDs users compared with non-infected users significantly increased the risk of DU (OR=4.78, P=0001) and decreased the risk of GU (OR=0.18, P=0.015), the risk of GIB did not increase significantly (OR= 0.54, P=013).

Conclusions: The findings of this study show that, either H. pylori or NSAIDs increase the risk of DU and bleeding, but H. pylori infection has a protective effect in reducing GU and bleeding in NSAIDs users and non-users.