Key result
H. pylori infection without NSAID use was associated with gastric ulcers on the lesser curvature (85% vs 35%), whereas NSAID use without H. pylori was associated with the greater curvature.
Observational (n=245)
Absolute Event Rate: 85% vs 35%
p-value: p=<0.01
NSAID use is highly associated with upper gastrointestinal bleeding in ulcer patients and with gastric ulcers located on the greater curvature, regardless of H. pylori status.
Ulcer location may suggest H. pylori versus NSAID etiology; hypothesis-generating and should not yet change practice.
BACKGROUND AND STUDY AIM: The aim of this study was to investigate the relationship between the presence and location of ulcers, H. pylori infection, NSAID use, and major upper gastrointestinal tract bleeding. PATIENTS AND METHODS: We studied 100 consecutive patients with duodenal ulcers and 145 consecutive patients with benign gastric ulcers. RESULTS: Ninety-nine percent of the duodenal ulcer patients and 92% of the gastric ulcer patients had H. pylori infection; all gastric ulcer patients without H. pylori infection were using NSAIDs. Gastric ulcers in patients with H. pylori infection who were not using NSAIDs were more likely to be on the lesser curvature (85%) than ulcers in NSAID users who had no H. pylori infection (35%) (p < 0.01). Conversely, only 5% of gastric ulcers in H. pylori-positive patients who were not using NSAIDs were on the greater curvature, compared to 45% in H. pylori-negative NSAID users (p < 0.01), and 23% in patients with both possible etiologies. The frequency of NSAID use was very high in patients presenting with upper gastrointestinal tract bleeding: 21 of 25 with gastric ulcers (84%) and 13 of 21 with duodenal ulcers (62%; p < 0.01 for each, compared to bleeding without taking NSAIDs). Overall, 74% of patients with upper gastrointestinal hemorrhage from peptic ulcer were taking NSAIDs. The prevalence of H. pylori infection was similar among the ulcer patients presenting with and without upper gastrointestinal tract bleeding. CONCLUSIONS: The location of a gastric ulcer on the greater curvature, and presentation with upper gastrointestinal tract bleeding, are separate and valuable clues to the involvement of NSAIDs. NSAID use may now be responsible for most bleeding complications of ulcer disease, regardless of H. pylori status.
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Al-Assi et al. (1996) conducted an observational in Duodenal and benign gastric ulcers (n=245). H. pylori infection without NSAID use vs. NSAID use without H. pylori infection was evaluated on Gastric ulcer located on the lesser curvature (p=<0.01). H. pylori infection without NSAID use was associated with gastric ulcers on the lesser curvature (85% vs 35%), whereas NSAID use without H. pylori was associated with the greater curvature.
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