These conflicting data with respect to the relationship between NSAIDs and H pylori infection have recently been partly clarified by a meta-analysis by Huang and colleagues. This study showed that H pylori infection is associated with a prevalence of peptic ulcers similar to that seen in NSAID users (25.0% and 26.0%, respectively) compared with non-NSAID-taking, non-H pylori-infected control subjects (5.5%). In NSAID users who are also infected with H pylori, the prevalence of ulcer is additive (49.2%). The prevalence of 5.5% reported in the present article represents the background level of peptic ulcer disease in the general population of people not taking NSAIDs and not infected with H pylori. This is consistent with the prevalence of 7.3% at 12 weeks reported for osteoarthritis patients taking placebo in a recent endoscopic study of an NSAID and the COX-2 selective inhibitor rofecoxib, and of 4% at 12 weeks in a trial of patients with rheumatoid arthritis taking celecoxib.
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Moreover, a prospective study showed that the six-month probability of developing an ulcer was reduced significantly by H pylori eradication before treatment with nonselective NSAIDs — 12.1% (95% CI 3.1 to 21.1) in the eradication group and 34.4% (95% CI 21.1 to 47.7) in the placebo group (P=0.0085). The corresponding six-month probabilities of complicated ulcers were 4.2% (95% CI 1.3 to 9.7) and 27.1% (95% CI 14.7 to 39.5; P=0.0026). An editorial that accompanied that paper and the metaanalysis suggested that H pylori-infected patients requiring NSAID therapy should be cured of H pylori infection before starting their NSAID treatment.