1. Peptic Ulcer Bleeding Risk. The Role of Helicobacter Pylori Infection in NSAID/Low-Dose Aspirin Users C. Sostres, MD, P. Carrera-Lasfuentes, PhD, R. Benito, MD, P. Roncales, M. Arruebo, MD, M.T. Arroyo, MD, L. Bujanda, MD, L.A. García-Rodríguez, MD and A. Lanas, MD Am J Gastroenterol 2015; 110:684-689 R3 이지훈 / Prof. 장영운

2. INTRODUCTION Helicobacter pylori ( H. pylori ) Nonsteroidal anti-inflammatory drugs (NSAIDs) Low-dose aspirin (ASA)

3. METHODS Hospital-based, case-control study with prospective case ascertainment Data collection carried out between 2006 and 2012 Cases and controls were collected in three general hospitals of the Spanish National Health System Eligible participants –20 to 85-year old –Free of liver disease, coagulation disorders or malignancies in the previous 5 years Study design and population

4. METHODS Case Patient hospitalized because of major UGIB (hematemesis or melena) Peptic ulcer lesion as determined in an endoscopic procedure Control Matched by age (±5 years), gender, hospital, and month of admission Exposure Current : taken up to 7 days before Past : the use ended earlier than 1 week Non-use : no mention of drug use Cardioprotective ASA (low dose) : any dose no greater than 300mg/d GI disorder history No history : no history of dyspepsia or ulcer Dyspepsia : history of dyspepsia only Ulcer : confirmed diagnosed ulcer Study design and population

5. METHODS Interviewed by the same persons (a gastroenterolotist or a gastroenterology trainee) within 48h of admission H. pylori status infection was determined in all cases and controls by serology ( H. pylori ELISA IgG) Blood samples were obtained at the time of interview Data collection

6. RESULTS Clinical variables, drug use, and H. pylori infection

7. RESULTS 34.5% of cases vs. 13.4% of controls [adjusted RR: 4.0 (95% CI; 3.0-5.4)] Ibuprofen (11.3 vs. 5.9%) ASA (high dose; 12.3 vs. 0.5%) Diclofenac (4.2 vs. 1.2%) Naproxen (2.1 vs. 1.5%) 15.8% of cases vs. 12.0% of controls [adjusted RR: 1.9 (95% CI; 1.3-2.7)] NSAID and/or low-dose ASA use

8. RESULTS NSAID or low-dose ASA interaction with H. pylori infection

9. RESULTS NSAID or low-dose ASA interaction with H. pylori infection

10. CONCLUSION NSAID, low-dose ASA use, and H. pylori infection are three independent risk factors for the development of PUB, but there were differences in the interaction effect between low-dose ASA or NSAID use and H. pylori infection There is an additive interaction between H. pylori infection and NSAID use on the risk of PUB There is no interaction between low-dose ASA use and H. pylori infection for the development of PUB