H. pylori eradication in NSAID - associated ulcers

Last reviewed 01/2018

This issue has been addressed in a Drug and Therapeutics Bulletin review (1):

  • if a patient is taking NSAID therapy then the presence of Helicobacter pylori infection increases the risk of developing gastric or duodenal ulcers
    • however, there is a lack of clear evidence or consensus among specialists on the value of eradicating H. pylori in patients with, or at high risk of developing, such ulcers
  • if starting patients on NSAID therapy for the first time who have dyspepsia or a previous history of ulceration, testing for and eradicating H. pylori is a reasonable management strategy
  • if a patient develops a gastric or duodenal ulcer associated whilst taking NSAIDs then s/he should ideally stop the NSAID and have ulcer-healing treatment
    • regarding eradication of H. pylori when there is peptic ulceration after NSAID or aspirin therapy:
      • no convincing evidence that eradication of H. pylori infection promotes ulcer-healing
      • if NSAIDs or aspirin are to be continued in those with a recent history of ulceration, treatment with a proton pump inhibitor is an important precaution and the patient should be monitored carefully for recurrence
      • if the NSAID is continued with a proton pump inhibitor then, despite being H. pylori positive, eradication therapy appears to provide no additional benefit.
      • some gastroenterologists specialists routinely test and eradicate H. pylori infection once the ulcer has healed - however, there is no published evidence to confirm the value of this approach

Reference:

  1. Drug and Therapeutics Bulletin (2005); 43:33-40.