Helicobacter pylori eradication reduced peptic ulcer incidence in NSAID users compared to control (7.4% vs 13.3%; OR 0.43), but was less effective than maintenance proton pump inhibitors.
Meta-Analysis (n=939)
Does Helicobacter pylori eradication prevent peptic ulcer in patients receiving non-steroidal anti-inflammatory drugs?
H. pylori eradication reduces peptic ulcer risk in NSAID users, particularly NSAID-naive patients, but is less effective than maintenance PPI therapy.
Effect estimate: OR 0.43 (95% CI 0.20-0.93)
Absolute Event Rate: 7.4% vs 13.3%
AIM: To evaluate whether eradication of Helicobacter pylori prevents peptic ulcer in non-steroidal anti-inflammatory drug users by means of a meta-analysis. MATERIAL AND METHODS: A systematic search was performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register and the AGA congress. Randomized trials comparing H. pylori eradication vs. non-eradication or eradication vs. a proton pump inhibitor in patients receiving a non-steroidal anti-inflammatory drug were selected. RESULTS: Five studies and 939 patients were included in the analysis; 34 of 459 (7.4%) patients developed a peptic ulcer in the eradicated group vs. 64 of 480 (13.3%) in the control group. The odds ratio was 0.43 (95% confidence interval: 0.20-0.93). Sub-analyses showed a significant reduction of risk for non-steroidal anti-inflammatory drug-naive (odds ratio = 0.26; 95% confidence interval: 0.14-0.49) but not for previously treated patients (odds ratio = 0.95, 95% confidence interval: 0.53-1.72). Two studies with a total of 385 patients compared eradication vs. a proton pump inhibitor; five of 196 (2.6%) developed a peptic ulcer in the eradicated group vs. zero of 189 (0%) in the proton pump inhibitor group (odds ratio = 7.43; 95% confidence interval: 1.27-43.6). CONCLUSION: Helicobacter pylori eradication reduces the incidence of peptic ulcer in the overall population receiving non-steroidal anti-inflammatory drugs. It appears to be especially effective when performed in non-steroidal anti-inflammatory drug-naïve patients. Nonetheless, eradication seems less effective than treatment with a maintenance proton pump inhibitor for preventing non-steroidal anti-inflammatory drug-associated ulcers.
Vergara et al. (Wed,) conducted a meta-analysis in peptic ulcer in NSAID users (n=939). Helicobacter pylori eradication vs. non-eradication or proton pump inhibitor was evaluated on peptic ulcer (OR 0.43, 95% CI 0.20-0.93). Helicobacter pylori eradication reduced peptic ulcer incidence in NSAID users compared to control (7.4% vs 13.3%; OR 0.43), but was less effective than maintenance proton pump inhibitors.
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