Peptic ulcer: Helicobacter pylori infection increased the risk of bleeding.

Clinical bottom line (level 3b)

  1. About a fifth of patients who used NSAIDs with a peptic ulcer will have bleeding.
  2. Patients who used NSAIDs with a peptic ulcer are at an increased risk of bleeding if they: have Helicobacter pylori infection, a history of bleeding peptic ulcer, dyspepsia within the last 3 months, or more than five alcoholic drinks per week.
Aalykke et al: Gastroenterology 1999; 116: 1305-1309
Expires February 2003

The study

Case-control study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, Denmark

268 patients (aged range 30 to 95 years; median 69, 52% female) signs of upper gastrointestinal bleeding with current NSAID use, and peptic ulcer or haemorrhagic gastritis (diagnosed with endoscopy)
Cases: 136 patients (48% female, mean age 72): signs of upper gastrointestinal bleeds and using NSAIDs
Controls: 132 patients (57% female, mean age 66): no signs of upper GI bleeding and current use of NSAIDs


Multivariate logistic regression analysis was performed to adjust for confounding factors.

Outcomes studied:
  • bleeding peptic ulcer among NSAID users

    • Case subjects were older than controls, and there were more males.

    The evidence

    Patient expected event rate for bleeding peptic ulcer among NSAID users: 20.0%
    risk factor for
    bleeding peptic ulcer among NSAID users     		adjusted OR
    (95% CI)    		 NNH
    (95% CI)
    Helicobacter pylori infection 1.81
    (1.02 to 3.21)     		9
    (4 to 314)
    history of bleeding peptic ulcer 4.08
    (1.37 to 12.1)     		3
    (2 to 18)
    dyspepsia within last 3 months 2.85
    (1.63 to 5.00)     		5
    (3 to 11)
    alcohol 2.39
    (1.16 to 4.89)     		6
    (3 to 40)

    Comments

    1. In the clinical setting knowing a patient's H. pylori status should not influence the way NSAIDs are used; all patients with a history of peptic ulcer should avoid them, regardless of H. pylori status.

    Citation

    1. Aalykke C, Lauitsen JM, Hallas J, et al: Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidal anti-inflammatory drugs: A case-control study. Gastroenterology 1999; 116: 1305-1309
    Contributor: Clare Wotton and Musab Hayatli, February 2000
    Reviewer: Goutham Rao

    Clinical Question.
    Patient using NSAIDs
    Intervention or Exposure H. pylori
    Comparison no H. pylori
    Outcome ulcer bleeding