NONSTEROIDAL ANTIINFLAMMATORY DRUGS ASSOCIATED WITH GASTRODUODENAL INJURY AND HELICOBACTER-PYLORI

Objective: To clarify the relationship between non-steroidal anti-inflammatory drug (NSAID)-associated gastroduodenal mucosal injury and Helicobacter pylori infection. Design and methods: The incidence of H. pylori infection was determined in a group of patients treated with NSAID for rheumatoid arthritis for greater than or equal to 3 months and in a control group of patients with mainly abdominal symptoms but without rheumatoid arthritis and not being treated with NSAID. The incidence of H. pylori infection was also determined in patients treated with different NSAID and antirheumatic drugs. In addition, the minimum inhibitory concentration of several NSAID against H. pylori was investigated. Results: The incidence of H.pylori infection in the NSAID group tended to be lower than in the control group, and was significantly lower in patients with gastric ulcers. The incidence of infection did not differ between patients treated with one or with more than one NSAID. Differences in the infection rate were found between individual NSAID, with indomethacin being associated with a particularly low rate. No differences in the infection rate were found between different antirheumatic drugs. The minimum inhibitory concentration of ibuprofen was low. Conclusion: H. pylori appears to have little effect on gastroduodenal mucosal injury associated with long-term NSAID administration.