三联疗法与序贯疗法在长期服用非甾体类抗炎药人群中根除幽门螺杆菌的疗效观察

目的 探讨长期服用非甾体类抗炎药(NSAID)的患者采用三联疗法与序贯疗法根除Hp的疗效.方法 以长期服用NSAID的患者为研究对象.将确诊的Hp感染者分为三联根除组和序贯根除组.三联根除组予埃索美拉唑+克拉霉素+阿莫西林治疗10 d;序贯根除组前5d予埃索美拉唑+阿莫西林,后5d予埃索美拉唑+克拉霉素+甲硝唑治疗.根除治疗结束后所有患者均予黏膜保护剂维持治疗,随访12周.随访前后行胃镜检查并检测Hp.对Hp根除率进行意向性分析和符合方案分析比较.结果 意向性分析显示,三联根除组和序贯根除组的Hp根除率分别为78.4％(40/51)和80.0％(40/50),两组差异无统计学意义(x2=0.038,P=0.846).符合方案分析显示,三联根除组和序贯根除组的Hp根除率分别为84.4％(38/45)和87.0％(40/46),两组差异无统计学意义(x2=0.117,P=0.732).结论 长期服用NSAID的患者采用三联疗法与序贯疗法根除Hp的疗效无显著差异.     

10天序贯和标准三联疗法根除幽门螺杆菌的疗效比较

目的评估新的序贯疗法对幽门螺杆菌的根除率。方法我院91例慢性胃炎患者纳入研究。幽门螺杆菌感染由组织学、尿素酶和尿素酶呼气试验评估。序贯疗法包括埃索美拉唑、阿莫西林治疗5天,随后以埃索美拉唑、克拉霉素和替硝唑治疗另外的5天。对照组标准三联疗法包括埃索美拉唑、阿莫西林和克拉霉素治疗10天。幽门螺杆菌的根除率以意向性分析(ITT)和完成治疗分析(PP)表示。根除疗效的判断根据治疗后6周的尿素酶呼气试验结果。结果序贯治疗对慢性胃炎患者的幽门螺杆菌感染获得86.36%(95%CI=81.19%-91.53%)和92.68%(95%CI=88.62%-96.74%)的根除率,但是和10天标准三联治疗相比较差异没有统计学意义。结论序贯治疗能获得较高的幽门螺杆菌根除率,但和10天标准三联治疗比较未获得显著的统计学差异。     

含替硝唑序贯疗法根除幽门螺杆菌62例

目的: 观察由泮托拉唑、替硝唑、阿莫西林、克拉霉素组成的10日序贯疗法根除幽门螺杆菌( H pylori)的疗效.方法: 将经胃镜检查确诊为慢性胃炎和消化性溃疡且H pylori阳性的患者120例随机分为两组, 治疗组(62例)方案为前5 d给予泮托拉唑+阿莫西林, 后5 d给予泮托拉唑+克拉霉素+替硝唑;对照组(58例)三联疗法为泮托拉唑+阿莫西林+克拉霉素, 疗程7 d. 比较治疗后两组患者H pylori根除率.结果: 治疗组和对照组H pylori ITT根除率分别为83.87%和67.24%, PP根除率分别为89.66%和72.22%, 两组分别有统计学意义( P<0.05).结论: 含替硝唑的10日序贯疗法治疗H pylori感染具有较高的根除率.     

短程三联疗法对功能性消化不良幽门螺杆菌感染的根除效果

目的　观察短程三联疗法对功能性消化不良 (FD)Helicobacterpylori感染的根除效果。方法　 73例H .pylori阳性的FD患者被随机分为A、B 2个治疗组 ,A组 (n =3 6) :奥美拉唑 2 0mgbid ,阿莫西林 1 0bid ,甲硝唑 0 4bid ,疗程 1周 ;B组 (n =3 7) :雷尼替丁 0 15bid ,阿莫西林 1 0bid ,甲硝唑 0 4bid ,疗程 1周 ;疗程结束时记录每组病人症状缓解情况 ,疗程结束后 1个月复查H .py lori。结果　H .pylori根除率分别为A组 5 2 8% (19/ 3 6)、B组 43 2 % (16/ 3 7) ,两组比较无统计学差异 (P >0 0 5 ) ,疗程结束时症状缓解率分别为A组 66 7% (2 4/ 3 6) ,B组 5 1 3 % (19/ 3 7) ,无统计学差异 (P >0 0 5 )。结论　本实验短程三联疗法对FD的H .pylori根除率及症状缓解率过低 ,不适合用于FD的H .pylori根治治疗     

Efficacy of levofloxacin-based triple therapy as second-line Helicobacter pylori eradication]

BACKGROUND/AIMS: Bismuth-based quadruple therapy for second-line eradication treatment achieves the eradication rate ranging from 70% to 81% due to antimicrobial resistance and poor compliance. The aim of this study was to compare the eradication rate of levofloxacin-based triple therapy with that of bismuth-based quadruple therapy in second-line Helicobacter pylori (H. pylori) eradication therapy. METHODS: Seventy-six outpatients with persistent H. pylori infection after first-line triple therapy were enrolled in this prospective randomized trial. The subjects were randomized to receive levofloxacin 300 mg, amoxicillin 1 g, and pantoprazole 20 mg, given twice daily for 7 days (LAP group), or metronidazole 500 mg twice, tetracycline 500 mg four times, and pantoprazole 20 mg twice, bismuth subcitrate 600 mg twice daily for 7 days (MTPB group). Eradication was confirmed with (13)C-urea breath test or rapid urease test 4 weeks after the cessation of therapy. RESULTS: Among Seventy-six patients initially included, eleven were lost during follow-up. The eradication rates, expressed as intention to treat (ITT) and per protocol (PP) analyses, were 51.6% and 53.3% in the LAP group, and 48.9% and 62.9% in the MTPB group, respectively. There was no significant difference in H. pylori eradication rates between the two groups (p=0.815 by ITT, p=0.437 by PP). LAP regimen was better tolerated than MTPB regimen with lower incidence of side effects (10.0% versus 31.4%, p=0.03). CONCLUSIONS: H. pylori eradication rates of levofloxacin-based triple therapy and bismuth-based quadruple therapy were not significantly different in second-line H. pylori eradication therapy, and low incidence of side effects was observed in levofloxacin-based triple therapy.     

Efficacy and safety of sequential therapy versus standard triple therapy in Helicobacter pylori eradication in Kashmir India: a randomized comparative trial

Background

Increasing resistance against Helicobacter pylori has resulted in reduced eradication rates.

Objective

This study aims to determine whether eradication rates for H. pylori infection with sequential therapy is better than standard triple therapy.

Patients

Patients with endoscopy documented peptic ulcer and H. pylori infection confirmed by histology and rapid urease test.

Intervention

Patients were randomized into two groups; 134 received standard triple therapy (pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1 g each administered twice daily) for 10 days and 138 received sequential regimen (pantoprazole 40 mg plus amoxicillin 1 g twice daily for 5 days followed by 40 mg pantoprazole, 500 mg clarithromycin, and 500 mg tinidazole each administered twice daily for 5 days). Eradication was confirmed by histology and rapid urease test. Compliance and adverse effects were determined by the recovery of empty medicine strips and questioning.

Results

The eradication rates with sequential therapy were significantly greater than with standard therapy on both intention-to-treat analysis (76.0 % vs. 61.9 %, p?=?0.005; difference, 14.1 % [95 % CI, 6.5–19 %] and per protocol analysis (84.6 % vs. 67.4 %, p?=?0.002; difference, 17.2 % [95 % CI, 8.5–23.5 %]). The incidence of side effects did not differ between the two therapy groups. One patient in standard therapy discontinued treatment due to side effects.

Limitation

Cultures were not performed. Loss to follow up was 5.2 % in standard therapy and 6.5 % in sequential therapy.

Conclusion

Sequential therapy was significantly more effective than standard therapy for eradicating H. pylori infection in peptic ulcer disease in Asian patients. Side effects were similar.     

Efficacy of moxifloxacin-based sequential and hybrid therapy for first-line Helicobacter pylori eradication

AIM: To evaluate the efficacy of moxifloxacin-based sequential therapy(MBST) versus hybrid therapy as a first-line treatment for Helicobacter pylori(H. pylori) infection.METHODS: From August 2014 to January 2015, 284 patients with confirmed H. pylori infection were randomized to receive a 14-d course of MBST(MBST group, n = 140) or hybrid(Hybrid group, n = 144) therapy. The MBST group received 20 mg rabeprazole and 1 g amoxicillin twice daily for 7 d, followed by 20 mg rabeprazole and 500 mg metronidazole twice daily, and 400 mg moxifloxacin once daily for 7 d. The Hybrid group received 20 mg rabeprazole and 1 g amoxicillin twice daily for 14 d. In addition, the Hybrid group received 500 mg metronidazole and 500 mg clarithromycin twice daily for the final 7 d. Successful eradication of H. pylori infection was defined as a negative 13C-urea breath test 4 wk after the end of treatment. Patient compliance was defined as "good" if drug intake was at least 85%. H. pylori eradication rates, patient compliance with treatment, and adverse event rates were evaluated.RESULTS: The eradication rates in the intention-totreat(ITT) analysis were 91.4%(128/140; 95%CI: 90.2%-92.9%) in the MBST group and 79.2%(114/144; 95%CI: 77.3%-80.7%) in the Hybrid group(P = 0.013). The eradication rates in the perprotocol(PP) analysis were 94.1%(128/136; 95%CI: 92.9%-95.6%) in the MBST group and 82.6%(114/138; 95%CI: 80.6%-84.1%) in the Hybrid group(P = 0.003). The H. pylori eradication rate in the MBST group was significantly higher than that of the Hybrid group for both the ITT(P = 0.013) and the PP analyses(P = 0.003). Both groups exhibited full compliance with treatment(MBST/Hybrid group: 100%/100%). The rate of adverse events was 11.8%(16/136) and 19.6%(27/138) in the MBST and Hybrid group, respectively(P = 0.019). The majority of adverse events were mild-to-moderate in intensity; none were severe enough to cause discontinuation of treatment in either group.CONCLUSION: MBST was more effective and led to fewer adverse events than hybrid therapy as a first-line treatment for H. pylori infection.     

亚洲人群中序贯疗法与三联疗法根除幽门螺旋杆菌临床疗效的Meta分析

目的评价在亚洲人群中序贯疗法与三联疗法根除幽门螺旋杆菌(Helicobacter pylori,H.pylori)临床疗效的差异。方法计算机检索中文数据库和外文数据库包括万方数据库、中国知网、维普数据库、中国生物医学文献数据库(CBM)、Medline/Pubmed、Embase、Wiley、Springer和Elsevier;手工检索《中华消化杂志》、《世界华人消化杂志》和会议记录。查找与此研究相关的临床随机对照试验(RCT)文献,采用Cochrane系统评价员手册5.0.2版推荐的方法纳入文献,并对其进行Meta分析。结果共纳入19篇临床随机对照(RCT)文献,纳入患者2 854例,其中采用序贯疗法的患者1 282例,采用三联疗法的患者1 572例。对19篇RCT研究进行Meta分析的结果显示:序贯疗法根除幽门螺旋杆菌(H.pylori)的疗效优于三联疗法,差异具有统计学意义(P0.05)。序贯疗法和三联疗法根除率的意向处理(ITT)分析分别为86.91%和73.47%(OR=2.43,95%CI:1.83~3.22,P0.05),序贯疗法与三联疗法根除率的试验方案(PP)分析分别为89.85%和77.32%(OR=2.51,95%CI:1.91~3.30,P0.05)。对于溃疡显效情况、疼痛缓解情况和不良反应发生情况等,由于条件所限未能进行Meta分析,仅进行了描述性分析。结论在亚洲人群中,序贯疗法较传统三联疗法具有较高的H.pylori根除率,为当前由于H.pylori抗生素耐药性提高而引起的三联疗法治疗成功率降低提供了一种新的选择,在临床上具有很好的应用前景。但目前相关RCT研究样本量少,且普遍质量较低。上述结论尚需要高质量、多中心、大样本量的随机双盲试验加以证实。     

Role of Helicobacter pylori eradication in aspirin or non-steroidal anti-inflammatory drug users

Helicobacter pylori(H pylori) infection and the use of non steroidal anti-inflammatory drugs (NSAIDs) including aspirin at any dosage and formulation represent well-established risk factors for the development of uncomplicated and complicated peptic ulcer disease accounting for the majority of such cases. Although the interaction between H pylori and NSAID/aspirin use in the same individuals was questioned in some epidemiological studies, it has now become widely accepted that they are at least independent risk factors for peptic ulcer disease. According to data from randomized intervention trials, naive NSAID users certainly benefit from testing for H pylori infection and, if positive, H pylori eradication therapy prior to the initiation of NSAID. A similar strategy is also suggested for naive aspirin users, although the efficacy of such an approach has not been evaluated yet. Strong data also support that chronic aspirin users with a recent ulcer complication should be tested for H pylori infection and, if positive, receive H pylori eradication therapy after ulcer healing, while they appear to benefit from additional long-term therapy with a proton pump inhibitor (PPI). A similar approach is often recommended to chronic aspirin users at a high risk of ulcer complication. H pylori eradication alone does not efficiently protect chronic NSAID users with a recent ulcer complication or those at a high-risk, who certainly should be treated with long-term PPI therapy, but H pylori eradication may be additionally offered even in this setting. In contrast, testing for H pylori or PPI therapy is not recommended for chronic NSAID/aspirin users with no ulcer complications or those at a low risk of complications.     

兰索拉唑三联疗法根除幽门螺杆菌的疗效及耐药研究

目的 研究以兰索拉唑为基础的不同治疗方案对幽门螺杆菌(H.pylori)根除率的影响并了解湖南地区H.pylori 耐药情况.方法 将76例H.pylori感染患者分成兰索拉唑加克拉霉素、阿莫西林组(LCA组)38例和兰索拉唑加克拉霉素与甲硝唑组(LCM组)38例,治疗1周,治疗前采用快速尿素酶试验(RUT)、14C-尿素呼气试验(14C-UBT)、组织学检查筛选,入选患者进行H.pylori培养及药物敏感性检测.治疗后停用抗生素至少4周行14C-UBT复查.结果 LCA组共有31例完成治疗,26例H.pylori 被根除, 根除率为83.87%;LCM组共有35例完成治疗,21例H.pylori 被根除, 根除率为60.00%.LCA组根除率明显高于LCM组(P＜0.05).阿莫西林、克拉霉素及甲硝唑耐药率分别为0.00%、28.00%和92.00%,对克拉霉素及甲硝唑均耐药率为24.00%;两组药物副作用发生率比较无明显差别(P＞0.05).结论 (1) 兰索拉唑联合克拉霉素、阿莫西林组较联合克拉霉素与甲硝唑组H.pylori根除率高;(2)湖南地区H.pylori对甲硝唑耐药率最高(92.00%),克拉霉素次之(28.00%).尚未发现对阿莫西林耐药的菌株.     

Helicobacter pylori management in non-steroidal anti-inflammatory drug therapy patients in primary care

Non-steroidal anti-inflammatory drugs (NSAIDs) may cause gastroduodenal ulcers and its complications. Helicobacter pylori infection is recognized as an additional risk factor for ulcer development, its eradication in NSAIDs users being recommended. In this cross-sectional study, during a 1-week period, consecutive patients who were routinely visiting in 58 primary care clinics were enrolled. A questionnaire was used to collect clinical data on the patients who were chronically taking NSAIDs. Patients with age >65?years, a personal history of peptic ulcer, concomitant therapy with steroids, anti-coagulants, multiple NSAIDs, or relevant co-morbidities were considered at high risk for NSAIDs gastroduodenal complications. Data on H. pylori infection management were collected. Overall, H. pylori was searched for in 140 (16.1%) out of 869 patients receiving chronic NSAID therapy, and it was eventually cured in 43 (72.9%) of the infected cases. In detail, H. pylori status was not investigated in 670 (77.1%) of those patients at high risk of NSAID-related gastroduodenal lesions, including 516 patients ??65?years old, and 154 younger, but with at least 1 adjunctive risk factor. In addition, 234 (35%) of these high-risk patients were not receiving any gastric mucosa protection. Our data find that H. pylori infection is investigated in fewer than one of every five NSAID-user patients in primary care. The low alertness towards such an infection in these patients suggests a need for prompt implementation of current guidelines.     

Dual versus triple therapy in eradication of Helicobacter pylori

BACKGROUND/AIMS: Duodenal ulcers should be treated by eradication of Helicobacter pylori. This study compared the efficacy of a proton pump inhibitor together with one or two antibiotics in eradication therapy. METHODOLOGY: 177 patients who were H. pylori positive were randomized to receive 14 days of either: lansoprazole 30 mg bd and amoxicillin 1 g bd (LA), omeprazole 20 mg bd and amoxicillin 1 g bd (OA) or lansoprazole 30 mg bd, amoxicillin 1 g bd and clarithromycin 500 mg bd (LAC). The efficacy was assessed at four weeks and at six months after the end of treatment. Biopsies were taken for culture and bacterial sensitivity testing at inclusion and at four weeks after the end of treatment. RESULTS: 149 patients were evaluated for efficacy. The eradication rate was significantly higher in LAC (96%) compared to LA (51%) and OA (64%) treatments (P < 0.001). At baseline 17%, 21% and 19% of the patients in the LA, OA and LAC groups, respectively, were resistant to metronidazole and only one patient was resistant to clarithromycin. Post-treatment, four patients had acquired metronidazole resistance. CONCLUSIONS: LAC is more effective than LA and OA for eradication of H. pylori in duodenal ulcer disease.     

Changes in Helicobacter pylori status in patients with rheumatoid arthritis under non-steroidal anti-inflammatory drugs

BACKGROUND: The role of Helicobacter pylori infection in rheumatoid arthritis (RA) patients during treatment with non-steroidal anti-inflammatory drugs (NSAID) is still unclear. METHODS: By means of endoscopy and biopsy, gastroduodenal lesions and H. pylori status were repeatedly examined in 88 RA patients at intervals ranging from 26 to 49 months. Histology and culture were applied to determine H. pylori status. Serial changes in gastroduodenal lesions and histologic score for mucosal atrophy were compared among groups classified by initial and second H. pylori status. RESULTS: There were 28 patients with continuously positive H. pylori infection (CP group), 33 patients with continuously negative H. pylori infection (CN group), 7 patients in whom H. pylori status became negative (PN group), and 20 patients in whom H. pylori status could not be determined (UD group). Age, duration and species of NSAID, disease activity of RA, gastroprotective drugs applied and the prevalence of gastroduodenal mucosal lesions were not different among the groups at either the initial or the second examination. In the PN group, the score for mucosal atrophy at the second examination was significantly lower than at the initial examination, whereas no difference was found for the CP, CN and UD groups. Overall, histologic score for mucosal atrophy was higher in H. pylori-positive patients than in H. pylori-negative patients at both initial and second examination. CONCLUSIONS: In RA patients using NSAIDs, H. pylori infection may not affect the course of gastroduodenal lesions and activity of RA, but the infection contributes to mucosal atrophy.     

Risk of ulcer bleeding in patients infected with Helicobacter pylori taking non-steroidal anti-inflammatory drugs

OBJECTIVE: To determine whether Helicobacter pylori is an independent risk factor for bleeding peptic ulcer in users of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. DESIGN: A prospective matched case-control study. SETTING: Odense University Hospital, Denmark. SUBJECTS: 132 patients with a bleeding peptic ulcer (n=124) or haemorrhagic gastritis (n=8) at endoscopy who had taken an NSAID in the previous week and 136 controls who had taken NSAIDs without gastrointestinal complications. The controls were recruited from rheumatology and geriatric outpatient clinics. MEASUREMENTS: H pylori status assessed by serology and 13C-urea breath test and regarded as positive if either test was positive. Data on potential confounding factors including smoking and alcohol were collected by interview. MAIN RESULT: H pylori was present in 57% of cases and 43% of controls. The adjusted odds ratio of bleeding from a peptic ulcer owing to H pylori infection in NSAID users was 1.81 (95% CI 1.02 to 3.21) and was similar in aspirin and non-aspirin NSAID users. Peptic ulcer bleeding was also statistically significantly associated with a history of previous ulcer bleeding, dyspepsia within the previous 3 months, drinking alcohol but not with smoking. About 16% of bleeding peptic ulcers in NSAID users could be attributed to H pylori infection. CONCLUSION: NSAID users infected with H pylori have an almost doubled risk of bleeding peptic ulcer compared with uninfected NSAID users.     

Helicobacter pylori does not play a part in the dyspeptic complaints of rheumatology patients receiving long term treatment with non-steroidal anti-inflammatory drugs

BACKGROUND: The presence of dyspeptic symptoms is a common finding in patients treated with non-steroidal anti-inflammatory drugs (NSAIDs). Some studies seem to support the involvement of Helicobacter pylori infection in the dyspeptic symptoms reported by these patients, and suggest that eradication may be useful. OBJECTIVE: To determine the variables related to dyspepsia in rheumatology patients requiring NSAID treatment, assessing in particular the role of Helicobacter pylori infection. METHODS: One hundred and eighty six consecutive patients with a rheumatological disorder requiring NSAID treatment (68 male, 118 female; mean (SD) age 55 (15) years) were included in a cross sectional study; dyspeptic symptoms were measured by a previously validated scale. Helicobacter pylori infection was determined by serology. Variables related to the severity of symptoms and the need for antisecretory drugs were determined by multivariate analysis. RESULTS: No relation was found between Helicobacter pylori infection and dyspepsia or any of its surrogate markers (antisecretory drug use or NSAID intolerance). Female sex and treatment with antisecretory drugs were found to be independent predictors for the appearance and severity of dyspeptic symptoms. The only independent predictive variables of the requirement for antisecretory drugs were age, previous ulcer disease, taking NSAIDs with a medium or high anti-inflammatory potential, and the symptoms score. CONCLUSION: Helicobacter pylori infection does not seem to play any part in the gastric symptoms of patients treated long term with NSAIDs.     

Efficacy of moxifloxacin-based sequential therapy for first-line eradication of Helicobacter pylori infection in gastrointestinal disease

AIM:To evaluate the efficacy of 14-d moxifloxacinbased sequential therapy as first-line eradication treatment of Helicobacter pylori(H.pylori) infection.METHODS:From December 2013 to August 2014, 161 patients with confirmed H.pylori infection randomly received 14 d of moxifloxacin-based sequential group(MOX-ST group, n = 80) or clarithromycin-based sequential group(CLA-ST group, n = 81) therapy.H.pylori infection was defined on the basis of at least one of the following three tests:a positive 13C-urea breath test; histologic evidence of H.pylori by modified Giemsa staining; or a positive rapid urease test(CLOtest; Delta West, Bentley, Australia) by gastric mucosal biopsy.Successful eradication therapy for H.pylori infection was defined as a negative 13C-urea breath test four weeks after the end of eradication treatment.Compliance was defined as good when drug intake was at least 85%.H.pylori eradication rates, patient compliance with drug treatment, adverse event rates, and factors influencing the efficacy of eradication therapy were evaluated.RESULTS:The eradication rates by intention-to-treat analysis were 91.3%(73/80;95%CI:86.2%-95.4%)in the MOX-ST group and 71.6%(58/81;95%CI:65.8%-77.4%)in the CLA-ST group(P=0.014).The eradication rates by per-protocol analysis were 93.6%(73/78;95%CI:89.1%-98.1%)in the MOX-ST group and 75.3%(58/77;95%CI:69.4%-81.8%)in the CLAST group(P=0.022).Compliance was 100%in both groups.The adverse event rates were 12.8%(10/78)and 24.6%(19/77)in the MOX-ST and CLA-ST group,respectively(P=0.038).Most of the adverse events were mild-to-moderate in intensity;there was none serious enough to cause discontinuation of treatmentin either group.In multivariate analysis,advanced age(≥60 years)was a significant independent factor related to the eradication failure in the CLA-ST group(adjusted OR=2.13,95%CI:1.97-2.29,P=0.004),whereas there was no significance in the MOX-ST group.CONCLUSION:The 14-d moxifloxacin-based sequential therapy is effective.Moreover,it shows excellent patient compliance and safety compared to the 14-d clarithromycin-based sequential therapy.     

Interaction between Helicobacter pylori and non-steroidal anti-inflammatory drugs in peptic ulcer bleeding

BACKGROUND: Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) are the two primary causes of peptic ulcer disease. How H. pylori and NSAIDs interact and influence the development of ulcer bleeding is still not clear. METHODS: A hospital-based, age- and sex-matched case-control study was conducted. Multivariate and stratified analyses were performed for further evaluation of the interaction between H. pylori and NSAIDs. RESULTS: Ninety-seven patients (52 gastric ulcers, 45 duodenal ulcers) and 97 non-ulcer controls were enrolled in the study. H. pylori and NSAIDs were both found to be independent risk factors for ulcer bleeding (H. pylori odds ratio, 2.22; 95% confidence interval (CI), 1.23-4.01; NSAIDs odds ratio, 4.57; 95% CI, 2.50-8.35). There was no synergistic effect. In contrast, a negative interaction was observed in the logistic regression and stratified analysis, although the difference was not significant (H. pylori adjusted odds ratio, 3.47; 95% CI, 1.73-6.95; NSAID adjusted odds ratio, 6.16; 95% CI, 3.14-12.09). CONCLUSION: H. pylori increases the risk of peptic ulcer bleeding but may play a protective role in NSAID users.