[Should Helicobacter pylori infection be tested and eradicated in patients treated or about to be treated with aspirin or nonsteroidal anti-inflammatory drugs?]

Abstract

Helicobacter pylori (H. pylori) and non-steroidal anti-inflammatory drugs (NSAIDs) are the main causes of gastroduodenal ulcers. Their coexistence is frequent in the elderly and raises the problem of their interaction. In the clinical setting, the question is whether or not H. pylori infection should be eradicated in patients with both risk factors. A number of epidemiological studies and more recently interventional studies have been performed to answer this question. Contradictory results have been reported. According to a meta-analysis, H. pylori and NSAIDs independently and significantly increase the risk of gastroduodenal ulcer and ulcer bleeding. However, these conclusions are not supported by more recent epidemiological and interventional studies. The critical review of these studies indicates that the discrepancy arises mainly from heterogeneity in risk factors, patients and outcome measurements. Among the main confounding factors are the type of treatment, non aspirin NSAIDs or low-dose aspirin, the different strains of H. pylori, the variable host response and the type of ulcer, gastric or duodenal. Based on the critical review of recent studies, recommendations are made about indications of H. pylori eradication in patients treated or about to be treated by NSAIDs or low-dose aspirin.