Bulletin Autumn‧Winter 2004

Eradication of Helicobacter pylori as a No v el Strategy f or t he Prevention of NSA I D - i n d u c ed Ulcers Helicobacter pylori A c c o r d i n g t o Prof. Chan, a current recommendation for h i g h - r i s k p a t i e n ts w i t h a r t h r i t is is co- p r e s c r i p t i o n o f N S A I D s w i t h a p o t e n t a c i d s u p p r e s s i ng d r u g ( p r o t o n p u m p inhibitor). H o w e v er this strategy requires e l d e r ly p a t i e n ts to take extra tablets. Furthermore, the long- t e r m cost of a c id s u p p r e s s i ng d r u gs is e n o r mo u s. A l t e r n a t i v e l y, one p o t e n t i al approach is to eliminate certain reversible r i s k f a c t o r s, o ne of w h i c h m i g h t be Helicobacter pylori infection. Like NSA I Ds, H. pylori infection is another important risk factor of peptic ulcer disease w o r l d w i d e. The ba c t e r i um is f o u nd i n the stomach of about 50 per cent of the local popu l a t i on. H. pylori i n d u c es i n f l a mm a t i on i n t he s t oma ch and, i n some patients, leads to ulcer f o rma t i on. A l t h o u gh b o t h H. pylori i n f e c t i on a nd N S A I Ds can cause pep t ic ulcers, whether curing the infection w o u l d p r e v e n t N S A I D - i n d u c ed u l c e rs w a s u n k n o w n . T h i s a l t e r n a t i v e u l c e r p r e v e n t i on strategy, if p r o v en effective, w o u l d have the potential of r edu c i ng the need for long-term acid suppressive drugs. Prof. Ch an and his team c ondu c t ed a s e r i es of p h a r m a c e u t i c al i n d u s t r y - i n d e p e n d e nt s t u d i es to a d d r e ss t h i s i m p o r t a nt c l i n i c al que s t i on. I n the f i r st study, they r a n d om ly assigned a g r oup of arthritis patients infected w i t h H. pylori to receive an N S A I D alone, or a course of antibiotics to eradicate H. pylori f o l l owed b y an NSA I D. Two mo n t hs later, patients w h o received antibiotics h a d an a l mo st f o u r - f o ld r e d u c t i on i n t he i n c i den ce of u l c e r s. To c o n f i r m t h i s p r e l i m i n a r y o b s e r v a t i o n, t h e y c o n d u c t ed a s e c o nd s t u dy i n w h i c h the treatment of arthritis was extended f r om t wo to six months. The second s t u dy s h owed that e l i m i n a t i on of H. pylori before starting long-term NSA I Ds effectively r e d u c ed the r i sk of ulcers b y over 65 per cent i n six months. T h e r e s e a r c h e rs f u r t h e r e x p l o r ed t he b e n e f i t of ‘ t e s t - a n d- treat H. pylori infection' i n p a t i e n ts r e c e i v i ng a s p i r i n w h o w e r e at h i g h r i s k o f u l c e r b l e e d i n g. I n the t h i r d study, t h ey c omp a r ed t h e e r a d i c a t i o n o f H. pylori infection alone w i t h maintenance acid s u p p r e s s i ve t h e r a p y f o r t he p r e v e n t i on of r e c u r r e nt b l e e d i ng i n Prof. Chan (middle) performs endoscopy to stop gastrointestinal bleeding Chinese University Bulletin Autumn • Winter 2004 50