Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial.

Autor: Chan, Francis K L, To, K F, Wu, Justin C Y, Yung, M Y, Leung, W K, Kwok, Timothy, Hui, Y, Chan, Henry L Y, Chan, Cynthia S Y, Hui, Elsie, Woo, Jean, Sung, Joseph J Y
Zdroj: Lancet (0099-5355); Jan2002, Vol. 359 Issue 9300, p9, 5p
Abstrakt: Background Whether Helicobacter pylori increases the risk of ulcers in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) is controversial. We hypothesised that eradication of H pylori infection would reduce the risk of ulcers for patients starting long-term NSAID treatment.Methods Patients were enrolled if they were NSAID naı¨ve, had a positive urea breath test, had dyspepsia or an ulcer history, and required long-term NSAID treatment. They were randomly assigned omeprazole triple therapy (eradication group) or omeprazole with placebo antibiotics (placebo group) for 1 week. All patients were given diclofenac slow release 100 mg daily for 6 months from randomisation. Endoscopy was done at 6 months or if severe dyspepsia or gastrointestinal bleeding occurred. The primary endpoint was the probability of ulcers within 6 months. Analyses were by intention to treat.Findings Of 210 arthritis patients screened, 128 (61%) were positive for H pylori. 102 patients were enrolled, and 100 were included in the intention-to-treat analysis. H pylori was eradicated in 90% of the eradication group and 6% of the placebo group. Five of 51 eradication-group patients and 15 of 49 placebo-group patients had ulcers. The 6-month probability of ulcers was 12·1% (95% CI 3·1–21·1) in the eradication group and 34·4% (21·1–47·7) in the placebo group (p=0·0085). The corresponding 6-month probabilities of complicated ulcers were 4·2% (1·3–9·7) and 27·1% (14·7–39·5; p=0·0026).Interpretation Screening and treatment for H pylori infection significantly reduces the risk of ulcers for patients starting long-term NSAID treatment. [Copyright &y& Elsevier]
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