Comment

Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) between them cause the vast majority of peptic ulcers and their complications. However, their interaction remains extremely controversial. Aalykke et al's study aimed to address this issue by investigatingH pylori status in a group of patients presenting with bleeding peptic ulcer and matched controls, all of whom were taking NSAIDs. The study found a relatively small increase (odds ratio 1.81) associated with H pyloriinfection, which only accounted for 16% of bleeding peptic ulcers in NSAID users. Although not investigated in this study,H pylori accounts for nearly all bleeding peptic ulcers in non-NSAID users.

These data are closely in line with a meta-analysis of studies of NSAID users investigated by endoscopy which also found a 1.8-fold increase in risk of peptic ulcer1 in NSAID users infected withH pylori compared with those not infected, although results from individual studies are variable. Unfortunately, there is also at least as much discrepancy in epidemiological studies of ulcer bleeding. Of six other studies, three have found no effect ofH pylori 2-4 and three have found evidence of possible protection,5-7 at least in some subgroups. The strength of the study by Aalykkeet al compared with these other studies is …