A systematic review 3 included 6 studies with a total of 1 207 subjects. A significant benefit of eradication was found in comparison with no eradication (5 RCTs, n=939; OR 0.43, 95% CI 0.20 to 0.93). The benefit of eradication was significant for new NSAID users (3 RCTs, n=532; OR 0.26 to 95% CI 0.14 to 0.49) but not for previous users (2 RCTs, n=407). Eradication significantly benefited patients without a history of ulcer (3 RCTs, n=572), reduced the risk of both duodenal and gastric ulcers (4 RCTs), and reduced the risk of bleeding ulcers (4 RCTs). Two RCTs (n=385) compared eradication with PPI treatment; the pooled analysis showed a significant benefit of PPI treatment (OR 7.43, 95% CI 1.27 to 43.64).
A randomised study 1 enrolled 100 patients who needed NSAIDs long term, but were NSAID-naive, and had dyspepsia or an ulcer history. All took omeprazole with either antibiotics or placebo for a week, plus diclofenac slow release tablets 100 mg daily for 6 months. At 6 months the probability of ulcers found endoscopically was 12% (95% CI 3.1 to 21.1) in the eradication group, but 34% (95% CI 21.1 to 47.7) in the placebo group (p=0.0085). The frequency of complicated (symptomatic or bleeding) ulcers was 4% in the eradication group and 27% in the placebo group.
According to a meta-analysis 2 of 25 observational studies, both H. pylori infection and NSAID use independently and significantly increase the risk of peptic ulcer and ulcer bleeding. There is synergism for the development of peptic ulcer and ulcer bleeding between H. pylori infection and NSAID use. Compared with H. pylori negative individuals not taking NSAIDs, the risk of ulcer in H. pylori positive NSAID takers was 61.1 (95% CI 9.98 to 373).
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