Clinical science of Helicobacter pylori infection: ulcers and NSAIDs

It is now clear that Helicobacter pylori is a major aetiological factor in peptic ulcer disease. About 95% of patients with duodenal ulcers and perhaps 80% of patients with gastric ulcers are infected with this bacterium and its eradication greatly diminishes recurrence of these ulcers. Many patients are still not receiving the benefit of this treatment, however. Most patients who have peptic ulcers without H. pylori infection are taking non-steroidal anti-inflammatory drugs (NSAIDs), although this may not be recognised or admitted. Such patients have to be managed by withdrawal of these agents or by giving protective agents such as misoprostol. If H. pylori is present in a patient who develops an ulcer whilst taking NSAIDs, it remains unclear whether it is beneficial to eradicate the infection, but this seems advisable in case the ulcer is due to the infection in that particular patient.