Nonsteroidal anti-inflammatory drugs, Helicobacter pylori, and ulcers: where we stand

Despite the progress in the diagnosis and treatment of Helicobacter pylori-related peptic ulcer disease, it has become apparent that we may be in the midst of an epidemic of nonsteroidal anti-inflammatory drug ulcers and ulcer complications. We also have almost no information about whether there is a link between ulcers in NSAID users and H. pylori infection or whether clinically significant interactions occur.

Current data regarding the diagnosis, prevention, and treatment of NSAID-induced ulcers and the possible relationship between H. pylori ulcers and NSAID use is reviewed.

We need to rethink past conclusions about NSAIDs and gastroduodenal complications and also re-do many of the experiments, taking into account the H. pylori status of the patient (infected, uninfected, cured). It is predicted that the epidemic of NSAID complications will only get worse. Only the future will tell whether selective COX II inhibitors or NO-NSAIDs that incorporate a nitroxybutyl moiety will actually provide the same benefit at lower risk. Until then we must rely on more rational use of NSAIDs, and misoprostol to keep the number of complications at a minimum.