Factors predisposing to endoscopic ulcer formation or healing with non-steroidal anti-inflammatory drugs (NSAIDs) have not previously been well defined.
Therefore, multivariate analysis has been used by researchers from England, Sweden and Australia, to identify factors associated with endoscopic lesions and healing.
The analysis was carried out on data from 3 large similar trials, and involved comparing the effectiveness of 3 different drug regimens in healing ulcers and erosions at different sites and in patients who were Helicobacter pylori-positive and negative.
Omeprazole 20 mg and 40 mg daily, misoprostol 200 µg four times daily, and ranitidine 150 mg twice daily were all investigated.
Following the analysis, older age, past ulcer history, rheumatoid arthritis, and H. pylori infection were found to be significantly associated with ulcers.
Duodenal ulcer was significantly more likely than gastric ulcer with a past ulcer history, H pylori infection, and male sex.
Female sex, older age (60 years), and higher NSAID dose (greater than 1 defined daily dose) however, were associated with gastric ulceration.
Sex differences were seen in both H. pylori-positive and negative patients.
Gastric and duodenal ulcer healing was significantly faster with omeprazole 20 mg than with misoprostol 200 µg four times daily or ranitidine 150 mg twice daily although misoprostol was more effective at healing erosions.
| Male gender - associated with duodenal ulceration|
Female gender - associated with gastric ulceration
Gastric ulcer healing was slower with large ulcers or a past ulcer history, and faster with H. pylori infection, especially with acid suppression (72% versus 37% at four weeks with ranitidine).
Professor C. J. Hawkey, one of the authors of the report, said the findings showed that among NSAID users, H. pylori and male sex independently increase the likelihood of duodenal ulceration.
He added that H. pylori infection does not affect duodenal ulcer healing and enhances gastric ulcer healing by ranitidine and possibly other acid-suppressing treatments.