H. pylori eradication in NSAID - associated ulcers

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.