CagA-positive Helicobacter pylori infection was associated with an increased risk of ulcer bleeding (OR 3.3; 95% CI 1.7-6.6), while its presence reduced the bleeding risk from non-aspirin NSAIDs.
Case-Control (n=406)
Yes
Does Helicobacter pylori infection and its interaction with NSAIDs or aspirin increase the risk of ulcer bleeding?
CagA positive H. pylori infection and low-dose aspirin are strongly associated with an increased risk of peptic ulcer bleeding.
Odds Ratio: 3.3 (95% CI 1.7–6.6)
AIM: To investigate the role of Helicobacter pylori, expressing the virulence marker CAGA (cytotoxin associated gene product A) in ulcer complications and its interaction with nonsteroidal anti-inflammatory drugs (NSAIDs) and other risk factors. DESIGN: Case control study using conditional logistic regression analysis. SETTING: University and City Hospitals, Nottingham. SUBJECTS: 203 consecutive patients with ulcer bleeding and 203 age- and sex-matched controls. RESULTS: Ulcer bleeding was more likely with positive H. pylori serology (odds ratio = 3.3, 95% CI: 1.7--6.6 for CagA positive, but only OR = 1.6, 95% CI: 0.7-3.7 for CagA negative serology), current smoking (OR 2.2, 95% CI: 1.04-4.7), aspirin < or = 300 mg daily (OR 7.7, 95% CI: 2.8-20.6), all other nonsteroidal anti-inflammatory drugs (NSAIDs: OR 10.6, 95% CI: 3.1-35.7 for < or = 1 defined daily dose lower and OR 22.6, 95% CI: 6.2-82.0 for higher doses) and past ulcer history (OR 5.6, 95% CI: 2.3-14.1). Aspirin < or = 300 mg daily was used by 25.1% of patients vs. 7.4% of controls. Smoking only enhanced risk in the presence of H. pylori, with a synergistic interaction (interaction odds ratio = 4.9, 2.4-9.9, P=0.002). Conversely, risks with non-aspirin NSAIDs were reduced in the presence of H. pylori, particularly if CagA-positive (interaction odds ratio=0.21, 0.05-0.9, P=0.03). CONCLUSIONS: CagA positive H. pylori infection is associated with an increased risk of ulcer bleeding. The risk from non-aspirin NSAIDs is even higher, but is less in H. pylori infected people. Low-dose aspirin is now commonly associated with ulcer bleeding.
Stack et al. (Fri,) conducted a case-control in peptic ulcer bleeding (n=406). CagA-positive Helicobacter pylori infection vs. CagA-negative serology or uninfected was evaluated on ulcer bleeding (OR 3.3, 95% CI 1.7-6.6). CagA-positive Helicobacter pylori infection was associated with an increased risk of ulcer bleeding (OR 3.3; 95% CI 1.7-6.6), while its presence reduced the bleeding risk from non-aspirin NSAIDs.
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