Kiltz U, Zochling J, Schmidt W E, Braun J
Rheumazentrum Ruhrgebiet, St. Josefs Hospital, Landgrafenstr. 15, 44652 Herne, Germany.
Rheumatology (Oxford). 2008 Sep;47(9):1342-7. doi: 10.1093/rheumatology/ken123. Epub 2008 May 13.
NSAID-induced gastroduodenal lesions are a frequent and potentially serious health problem in patients with rheumatic diseases. Helicobacter pylori (H. pylori) has also been recognized as a major risk factor for the development of ulcer disease. However, the role of H. pylori in the pathogenesis of NSAID-induced gastroduodenal lesions has remained controversial, and there is currently no clear consensus on the management of NSAID users who are infected with H. pylori.
To clarify this situation we have performed a systematic literature search to find randomized controlled trials comparing the efficacy of eradication in patients receiving NSAIDs to prevent ulcer development.
Seven randomized controlled trials and one meta-analysis were identified. There were three papers on NSAID-naive patients. According to this data, NSAID-naive users benefit from testing for H. pylori infection and subsequent H. pylori eradication therapy prior to the initiation of NSAID. In contrast, H. pylori eradication alone does not protect chronic NSAID users with recent ulcer complications from further gastrointestinal (GI) events. To prevent recurrent ulcer bleeding long-term acid suppressive therapy is needed.
In conclusion, ulcer risk reduction after H. pylori eradication therapy is clearly more marked in patients beginning NSAID therapy than in patients who were already receiving and tolerating NSAID therapy. Thus, the management of H. pylori infection and the prevention of GI complications in NSAID users need to be individualized on the basis of recently published data.
非甾体抗炎药（NSAID）引起的胃十二指肠病变是风湿病患者常见且可能严重的健康问题。幽门螺杆菌（H. pylori）也被认为是溃疡病发生的主要危险因素。然而，幽门螺杆菌在NSAID引起的胃十二指肠病变发病机制中的作用仍存在争议，目前对于感染幽门螺杆菌的NSAID使用者的管理尚无明确共识。
为了阐明这种情况，我们进行了系统的文献检索，以寻找比较接受NSAID治疗的患者根除幽门螺杆菌预防溃疡发生疗效的随机对照试验。
共鉴定出7项随机对照试验和1项荟萃分析。有3篇关于未使用过NSAID患者的论文。根据这些数据，未使用过NSAID的使用者在开始使用NSAID之前进行幽门螺杆菌感染检测及随后的幽门螺杆菌根除治疗有益。相比之下，单独根除幽门螺杆菌并不能保护近期有溃疡并发症的慢性NSAID使用者免受进一步的胃肠道（GI）事件影响。为预防复发性溃疡出血，需要长期进行抑酸治疗。
总之，与已经接受并耐受NSAID治疗的患者相比，开始NSAID治疗的患者在根除幽门螺杆菌治疗后溃疡风险降低更为明显。因此，应根据最近发表的数据对NSAID使用者的幽门螺杆菌感染管理和GI并发症预防进行个体化处理。
