Is Helicobacter pylori a risk factor for NSAID-associated gastric ulcer bleeding? A sex- and age-matched case-control study

Helicobacter pylori infection and nonsteroidal anti-inflammatory drug (NSAID) use are the two major factors that interfere with gastric mucosa protective mechanisms, but their correlation with gastric ulcer bleeding remains controversial. Seventy-two patients with bleeding gastric ulcers and 72 sex- and age-matched controls; with nonbleeding gastric ulcers were studied. H. pylori infection status, NSAID use history, gastric ulcer size, location, and stage, previous ulcer history, H-2-blocker treatment history and duration, smoking habits, alcohol consumption, Chinese tea drinking habits, and concomitant diseases were analyzed. Multivariate analysis using logistic regression was performed to identify the independent risk factors for gastric ulcer bleeding. Univariate analysis revealed that NSAID use and gastric ulcer size and stage were significant risk factors for gastric ulcer bleeding and that H. pylori infection increased this risk, but not significantly. H. pylori infection became an independent risk factor when we controlled NSAID use and gastric ulcer size and stage by logistic regression. Stratified analysis revealed negative interaction between H. pylori and NSAID use when they existed simultaneously. H. pylori infection and NSAID use were both independent risk factors for gastric ulcer bleeding; their interaction was negative rather than synergistic.