Review
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World J Gastroenterol. Jul 28, 2014; 20(28): 9439-9450
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9439
Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: Old question new insights
Carlos Sostres, Carla Jerusalen Gargallo, Angel Lanas
Carlos Sostres, Carla Jerusalen Gargallo, Angel Lanas, Service Department of Digestive Diseases, University Hospital Lozano Blesa, 50009 Zaragoza, Spain
Carlos Sostres, Carla Jerusalen Gargallo, Angel Lanas, Digestive Diseases Department, Aragon Health Sciences Institute, 50009 Zaragoza, Spain
Angel Lanas, CIBERehd, 08036 Barcelona, Spain
Angel Lanas, University of Zaragoza (Zaragoza), 50009 Zaragoza, Spain
Author contributions: Sostres C, Gargallo CJ and Lanas A contributed equally to the design, redaction drafting and reviewing process of this paper.
Correspondence to: Angel Lanas, MD, DSc, Clinical Chief, Professor, Service Department of Digestive Diseases, University Hospital Lozano Blesa, c/Domingo Miral s/n, 50009 Zaragoza, Spain. alanas@unizar.es
Telephone: +34-97-6765786 Fax: +34-97-6765787
Received: October 25, 2013
Revised: January 15, 2014
Accepted: April 8, 2014
Published online: July 28, 2014
Abstract

Previous reports clearly demonstrated that Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drugs (NSAID) or low dose aspirin (ASA) use significantly and independently increased the risk for the development of peptic ulcer disease. Today, the presence of H. pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications. Whether NSAID intake in the presence of H. pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate. Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years. In addition, the interaction between H. pylori infection and low-dose ASA remains even more controversial. In real clinical practice, we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors. These huge variety of possible combinations greatly hinder the decision making process of physicians.

Keywords: Nonsteroidal anti-inflammatory drugs, Low dose aspirin, Helicobacter pylori infection, Helicobacter pylori eradication, Peptic ulcer disease

Core tip:Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drugs (NSAID) or low dose aspirin use independently increases the risk for the development of peptic ulcer disease. In clinical practice, the presence of H. pylori infection associated with low dose aspirin and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications. In real clinical practice, we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors. These huge variety of possible combinations greatly hinder the decision making process of physicians.