Helicobacter pylori and nonsteroidal anti-inflammatory drugs

The interaction between Helicobacter pylori and NSAIDs is not a simple all-or-none relationship. Current evidence suggests that H. pylori increases the risk of ulcer in patients who are about to start NSAIDs, whereas NSAIDs cause the majority of ulcer complication in chronic NSAID users irrespective of the H. pylori status. In addition, H. pylori plays a more important role in ulcer bleeding associated with low-dose aspirin than in bleeding associated with non-aspirin NSAIDs. Eradication of H. pylori has been shown to prevent recurrent ulcer bleeding associated with low-dose aspirin but not with non-aspirin NSAIDs. With an increasing use of COX-2 selective NSAIDs and prophylactic low-dose aspirin, the relative importance of H. pylori in peptic ulcer disease is expected to increase.