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Lim and Hong: Helicobacter pylori Infection in Nonsteroidal Anti-inflammatory Drug Users
Review Article

Korean J Gastroenterol 2014;64(2):70-75.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.2.70

Helicobacter pylori Infection in Nonsteroidal Anti-inflammatory Drug Users

Yun Jeong Lim, Su Jin Hong1

Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea

1Digestive Disease Center and Research Institute, Soonchunhyang University College of Medicine, Bucheon, Korea

Correspondence to: Su Jin Hong, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea. Tel: +82-32-621-5087, Fax: +82-32-621-5080, E-mail: sjhong@schmc.ac.kr

Copyright © 2014 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

NSAID-induced upper gastrointestinal (GI) damage occurs easily in people with a prior history of complicated or uncomplicated ulcers. Many recent clinical studies have proved the benefit of Helicobacter pylori eradication in NSAID users; however, the exact pathophysiologic relationship between concomitant H. pylori infection and NSAID use has not yet been fully elucidated. Testing and eradication of H. pylori are generally recommended in patients who are at a high risk for NSAID-induced GI damage. However, in high-risk patients, ulcer prophylaxis with proton pump inhibitor or misoprostol is needed even if H. pylori has been successfully eradicated. In low-risk patients, it is still questionable whether or not eradication of H. pylori can reduce upper GI damage. However, in western countries, due to its cost effectiveness, testing and eradication of H. pylori is recommended before starting aspirin or NSAID irrespective of the risk level. In regions with a high prevalence of H. pylori infection (＞20%), the usefulness of testing and eradication of H. pylori has not yet been determined.

Keywords: Anti-inflammatory agents, non-steroidal, Helicobacter pylori, Peptic ulcer

References

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Table 1.
Recommended Guidelines for Helicobacter pylori Eradication in NSAID or Aspirin Users
  High risk for peptic ulcer Low risk for peptic ulcer
Naïve NSAID users H. pylori eradication irrespective of H. pylori prevalence H. pylori eradication in population with a low prevalence because of cost effectiveness
    H. pylori eradication in population with a high prevalence is controversial
Chronic NSAID users H. pylori eradication and PPI maintenance Not recommended
Low‐ dose aspirin users H. pylori eradication and/or PPI maintenance Controversial

PPI, proton pump inhibitor.

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