Interaction between Helicobacter pylori and non-steroidal anti- inflammatory drugs in peptic ulcer bleeding

Background: Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) are the two primary causes of peptic ulcer disease. How H. pylori and NSAIDs interact and influence the development of ulcer bleeding is still not clear. Methods: A hospital-based, age- and sex-matched case- control study was conducted. Multivariate and stratified analyses were performed for further evaluation of the interaction between H. pylori and NSAIDs. Results: Ninety-seven patients (52 gastric ulcers, 45 duodenal ulcers) and 97 non ulcer controls were enrolled in the study. H. pylori and NSAIDs were both found to be independent risk factors for ulcer bleeding (H. pylori odds ratio, 2.22; 95% confidence interval (CI), 1.234.01; NSAIDs odds ratio, 4.57; 95% CI 2.50-8.35). There was no synergistic effect. In contrast, a negative interaction was observed in the logistic regression and stratified analysis, although the difference was not significant (H. pylori adjusted odds ratio, 3.47; 95% CI, 1.73-6.95; NSAID adjusted odds ratio, 6.16; 95% CI, 3.14-12.09). Conclusion: H. pylori increases the risk of peptic ulcer bleeding but may play a protective role in NSAID users.