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Rheumatology Advance Access published online on May 13, 2008
Rheumatology, doi:10.1093/rheumatology/ken123
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Use of NSAIDs and infection with Helicobacter pylori—what does the rheumatologist need to know?

U. Kiltz1, J. Zochling1, W. E. Schmidt2 and J. Braun1

1Rheumazentrum Ruhrgebiet, St. Josefs Hospital, Landgrafenstr, Herne and 2Department of Medicine I, St. Josef Hospital, Ruhr-University of Bochum Medical School, Bochum, Germany.

Correspondence to: U. Kiltz, Rheumazentrum Ruhrgebiet, St. Josefs Hospital, Landgrafenstr. 15, 44652 Herne, Germany. E-mail: kiltz{at}rheumazentrum-ruhrgbiet.de


  Abstract

Objectives. NSAID-induced gastroduodenal lesions are a frequent and potentially serious health problem in patients with rheumatic diseases. Helicobacter pylori (H. pylori) has also been recognized as a major risk factor for the development of ulcer disease. However, the role of H. pylori in the pathogenesis of NSAID-induced gastroduodenal lesions has remained controversial, and there is currently no clear consensus on the management of NSAID users who are infected with H. pylori.

Methods. To clarify this situation we have performed a systematic literature search to find randomized controlled trials comparing the efficacy of eradication in patients receiving NSAIDs to prevent ulcer development.

Results. Seven randomized controlled trials and one meta-analysis were identified. There were three papers on NSAID-naive patients. According to this data, NSAID-naive users benefit from testing for H. pylori infection and subsequent H. pylori eradication therapy prior to the initiation of NSAID. In contrast, H. pylori eradication alone does not protect chronic NSAID users with recent ulcer complications from further gastrointestinal (GI) events. To prevent recurrent ulcer bleeding long-term acid suppressive therapy is needed.

Conclusions. In conclusion, ulcer risk reduction after H. pylori eradication therapy is clearly more marked in patients beginning NSAID therapy than in patients who were already receiving and tolerating NSAID therapy. Thus, the management of H. pylori infection and the prevention of GI complications in NSAID users need to be individualized on the basis of recently published data.

KEY WORDS: Non-steroidal anti-inflammatory drugs, Helicobacter pylori, Eradication, Gastroduodenal lesions, Rheumatoid arthritis

Submitted 2 July 2007; revised version accepted 22 February 2008.
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