OBJECTIVE: The objective of this study was to identify the risk factors in NSAID users.
STUDY DESIGN AND SETTING: Comparative prospective study, performed at the Department of
Pharmacology and Therapeutics BMSI, JPMC with the collaboration of Departments of Medicine
and Rheumatology JPMC Karachi from February 2008 to August 2008.
MATERIALS AND METHODS: This study was performed on endoscopically diagnosed patients
of NSAID induced peptic ulcers, in whom a clinical trial was performed between Ranitidine (H2
Receptor blocker) and new proton pump inhibitor Esomeprazole. Eighty Patients were selected
and evaluated for presence of risk factors and dyspepsia after consumption of NSAIDs or low
dose aspirin for last 6 months to 1 year. They were asked to fill in a specially designed proforma
regarding the use of NSAIDs, which also included the questions for their social setup, habits
and diseases for which they were taking them. All the patients were tested for presence of H.
pylori infection and anti-H. pylori IgG antibody titers were determined by enzyme-linked immunosorbent
assay. Patients taking anticoagulants and steroids were excluded from the study.
RESULTS: Important factors that have been shown to increase the risk of NSAID-associated GI
complications in our study included female gender (76%) presence of H.pylori infection (71%),
combination of two NSAIDs (23.75%) and high-dose NSAID use (20%). Other factors that may
increase risk include social habits like heavy consumption of tea (30%), pan or Gutka consumption
(8.75%). Current evidence supports that H. pylorus potentates the risk of NSAID-induced
gastrointestinal ulcers or clinical events, and a strategy of H. pylori testing and treatment in
NSAID users may be adopted.
CONCLUSIONS: The incidence of NSAID related gastrointestinal problems was present in 10-
15% of patients who belonged to high risk group. Identifying them is strongly recommended to
avoid serious complications. H. pylori infection may also be eradicated before initiating NSAID
Key words: Non-steroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori (H. pylori),