Korean J Gastroenterol.  2020 Nov;76(5):227-231. 10.4166/kjg.2020.141.

Helicobacter pylori Eradication in Drug-related Peptic Ulcer

• Joo MK

• KMID: 2508870
• DOI: http://doi.org/10.4166/kjg.2020.141

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin are the most frequently prescribed drugs worldwide, and their long-term use often leads to peptic ulcers (PUs) along with serious complications, such as bleeding and perforation. Helicobacter pylori (H. pylori) infection is a significant risk factor for developing NSAID-related PU and ulcer bleeding during long-term aspirin use. In a revised version of the Clinical Guidelines for Drug-induced Peptic Ulcer, two statements regarding H. pylori eradication are recommended. 1) Patients scheduled for long-term NSAID therapy should be tested and treated for H. pylori infection to prevent PU and its complications. 2) Patients with a history of PU receiving long-term low-dose aspirin (LDA) therapy should undergo treatment for H. pylori infection to prevent PU and its complications. On the other hand, unlike NSAID-naïve patients, the preventive effects of H. pylori eradication in chronic NSAID users are unclear. In addition, anti-ulcer drugs, such as proton pump inhibitors, may be necessary for maintenance therapy after H. pylori eradication in a subset of long-term LDA users, particularly if the patients are taking concomitant antiplatelet agents or anticoagulants.

Keyword

Peptic ulcer; Anti-inflammatory agents; non-steroidal; Aspirin; Helicobacter pylori

Reference

1. Lanza FL, Chan FK, Quigley EM. Practice Parameters Committee of the American College of Gastroenterology. 2009; Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 104:728–738. DOI: 10.1038/ajg.2009.115. PMID: 19240698.

2. Kim SG, Kim JG, Shin SK, et al. 2009; Guidelines of diagnosis for peptic ulcer disease. Korean J Gastroenterol. 54:279–284. DOI: 10.4166/kjg.2009.54.5.279. PMID: 19934609.

3. Kim JH, Moon JS, Jee SR, et al. 2009; Guidelines of treatment for peptic ulcer disease in special conditions. Korean J Gastroenterol. 54:318–327. DOI: 10.4166/kjg.2009.54.5.318. PMID: 19934613.

4. Lee JH, Lee YC, Jeon SW, et al. 2009; Guidelines of prevention and treatment for NSAID-related peptic ulcers. Korean J Gastroenterol. 54:309–317. DOI: 10.4166/kjg.2009.54.5.309. PMID: 19934612.

5. Cheung DY, Jung HY, Song HJ, et al. 2009; Guidelines of treatment for non-bleeding peptic ulcer disease. Korean J Gastroenterol. 54:285–297. DOI: 10.4166/kjg.2009.54.5.285. PMID: 19934610.

6. Chung IK, Lee DH, Kim HU, et al. 2009; Guidelines of treatment for bleeding peptic ulcer disease. Korean J Gastroenterol. 54:298–308. DOI: 10.4166/kjg.2009.54.5.298. PMID: 19934611.

7. Shim YK, Kim N. 2016; Nonsteroidal anti-inflammatory drug and aspirin-induced peptic ulcer disease. Korean J Gastroenterol. 67:300–312. DOI: 10.4166/kjg.2016.67.6.300. PMID: 27312830.

8. Rostom A, Moayyedi P, Hunt R. Canadian Association of Gastroenterology Consensus Group. 2009; Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: benefits versus risks. Aliment Pharmacol Ther. 29:481–496. DOI: 10.1111/j.1365-2036.2008.03905.x. PMID: 19053986.

9. Satoh K, Yoshino J, Akamatsu T, et al. 2016; Evidence-based clinical practice guidelines for peptic ulcer disease 2015. J Gastroenterol. 51:177–194. DOI: 10.1007/s00535-016-1166-4. PMID: 26879862.

10. Joo MK, Park CH, Kim JS, et al. 2020; Clinical guidelines for drug-induced peptic ulcer, 2020 revised edition. Korean J Gastroenterol. 76:108–133. DOI: 10.4166/kjg.2020.76.3.108. PMID: 32969360.

11. Chan FK, Sung JJ, Chung SC, et al. 1997; Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet. 350:975–979. DOI: 10.1016/S0140-6736(97)04523-6. PMID: 9329511.

12. Chan FK, To KF, Wu JC, et al. 2002; Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial. Lancet. 359:9–13. DOI: 10.1016/S0140-6736(02)07272-0. PMID: 11809180.

13. Labenz J, Blum AL, Bolten WW, et al. 2002; Primary prevention of diclofenac associated ulcers and dyspepsia by omeprazole or triple therapy in Helicobacter pylori positive patients: a randomised, double blind, placebo controlled, clinical trial. Gut. 51:329–335. DOI: 10.1136/gut.51.3.329. PMID: 12171952. PMCID: PMC1773346.

14. de Leest HT, Steen KS, Lems WF, et al. 2007; Eradication of Helicobacter pylori does not reduce the incidence of gastroduodenal ulcers in patients on long-term NSAID treatment: double-blind, randomized, placebo-controlled trial. Helicobacter. 12:477–485. DOI: 10.1111/j.1523-5378.2007.00543.x. PMID: 17760715.

15. Hawkey CJ, Tulassay Z, Szczepanski L, et al. 1998; Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter eradication for lesion prevention. Lancet. 352:1016–1021. DOI: 10.1016/S0140-6736(98)04206-8. PMID: 9759744.

16. Lai KC, Lam SK, Chu KM, et al. 2003; Lansoprazole reduces ulcer relapse after eradication of Helicobacter pylori in nonsteroidal anti-inflammatory drug users--a randomized trial. Aliment Pharmacol Ther. 18:829–836. DOI: 10.1046/j.1365-2036.2003.01762.x. PMID: 14535877.

17. Sostres C, Gargallo CJ, Lanas A. 2014; Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: old question new insights. World J Gastroenterol. 20:9439–9450. DOI: 10.3748/wjg.v20.i28.9439. PMID: 25071338. PMCID: PMC4110575.

18. Chey WD, Leontiadis GI, Howden CW, Moss SF. 2017; ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 112:212–239. DOI: 10.1038/ajg.2016.563. PMID: 28071659.

19. Kim SG, Jung HK, Lee HL, et al. 2014; Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition. J Gastroenterol Hepatol. 29:1371–1386. DOI: 10.1111/jgh.12607. PMID: 24758240.

20. Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sáinz R. 2002; Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther. 16:779–786. DOI: 10.1046/j.1365-2036.2002.01230.x. PMID: 11929396.

21. Yeomans ND, Lanas AI, Talley NJ, et al. 2005; Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther. 22:795–801. DOI: 10.1111/j.1365-2036.2005.02649.x. PMID: 16225488.

22. Malfertheiner P, Megraud F, O'Morain CA, et al. 2017; Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 66:6–30. DOI: 10.1136/gutjnl-2016-312288. PMID: 27707777.

23. Pilotto A, Franceschi M, Longoa MG, et al. 2004; Helicobacter pylori infection and the prevention of peptic ulcer with proton pump inhibitors in elderly subjects taking low-dose aspirin. Dig Liver Dis. 36:666–670. DOI: 10.1016/j.dld.2004.05.011. PMID: 15506665.

24. Feldman M, Cryer B, Mallat D, Go MF. 2001; Role of Helicobacter pylori infection in gastroduodenal injury and gastric prostaglandin synthesis during long term/low dose aspirin therapy: a prospective placebo-controlled, double-blind randomized trial. Am J Gastroenterol. 96:1751–1757. DOI: 10.1111/j.1572-0241.2001.03928.x. PMID: 11419825.

25. Shiotani A, Sakakibara T, Yamanaka Y, et al. 2009; Upper gastrointestinal ulcer in Japanese patients taking low-dose aspirin. J Gastroenterol. 44:126–131. DOI: 10.1007/s00535-008-2290-6. PMID: 19214674.

26. Koh JS, Joo MK. 2018; The role of Helicobacter pylori infection in drug-induced peptic ulcer. Korean J Helicobacter Up Gastrointest Res. 18:89–94. DOI: 10.7704/kjhugr.2018.18.2.89.

27. Chan FK, Chung SC, Suen BY, et al. 2001; Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med. 344:967–973. DOI: 10.1056/NEJM200103293441304. PMID: 11274623.

28. Chan FK, Ching JY, Suen BY, Tse YK, Wu JC, Sung JJ. 2013; Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology. 144:528–535. DOI: 10.1053/j.gastro.2012.12.038. PMID: 23333655.

29. Chan FK, Kyaw M, Tanigawa T, et al. 2017; Similar efficacy of proton-pump inhibitors vs H2-receptor antagonists in reducing risk of upper gastrointestinal bleeding or ulcers in high-risk users of low-dose aspirin. Gastroenterology. 152:105–110.e1. DOI: 10.1053/j.gastro.2016.09.006. PMID: 27641510.