Risk of ulcer bleeding in patients infected with Helicobacter pylori taking non-steroidal anti-inflammatory drugs

Abstract

These data are closely in line with a meta-analysis of studies of NSAID users investigated by endoscopy which also found a 1.8-fold increase in risk of peptic ulcer1 in NSAID users infected withH pylori compared with those not infected, although results from individual studies are variable. Unfortunately, there is also at least as much discrepancy in epidemiological studies of ulcer bleeding. Of six other studies, three have found no effect ofH pylori 2-4 and three have found evidence of possible protection,5-7 at least in some subgroups. The strength of the study by Aalykkeet al compared with these other studies is that it involved a direct comparison restricted to NSAID using cases and controls. The study also has a number of weaknesses. Despite attempts to match and allow for the effect of age, it is unfortunate that controls were on average six years younger than cases. The study did not match for social class, and use of controls from the rheumatology clinic could have spuriously biased the study results if these controls were of a higher socioeconomic group.