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JayaKrishna Chintanaboina MBBS Stanley J Pietrak MD

Effect of Helicobacter pylori infection on Non-steroidal Anti-inflammatory Drug (including Acetylsalicylic acid) induced Gastric Damage: A Protector or Disaster?. JayaKrishna Chintanaboina MBBS Stanley J Pietrak MD. NSAID-induced Gastric damage. Most commonly used medications

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JayaKrishna Chintanaboina MBBS Stanley J Pietrak MD

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  1. Effect of Helicobacter pylori infection on Non-steroidal Anti-inflammatory Drug (including Acetylsalicylic acid) induced Gastric Damage: A Protector or Disaster? JayaKrishna Chintanaboina MBBS Stanley J Pietrak MD

  2. NSAID-induced Gastric damage • Most commonly used medications • 30 billion OTC pills/year • 70 million prescriptions/year • Bleeding / Perforation- 3-4% users/year • Mortality - 20,000 patients/year

  3. Gastroduodenal mucosal defense Components involved in providing gastroduodenal mucosal defense and repair.

  4. NSAID-induced gastric damage Mechanisms by which NSAIDs may induce mucosal injury

  5. Helicobacter pylori • Barry Marshall and Robin Warren in 2005 • Prevalence in USA – 30% • < 30yrs of age – 10% • < 50yrs of age - 50% • Rate of infection is USA : Declined • Route of transmission • Frank peptic ulceration -10-15%

  6. Risk Factors for H.pylori infection • Birth or residence in a developing country • Low socioeconomic status • Domestic crowding • Unsanitary living conditions • Unclean food or water • Exposure to gastric contents of infected individual

  7. Helicobacter pylori Potential mechanisms by which H. pylori may lead to gastric secretory abnormalities

  8. Diagnostic tests • Radiographic Barium studies • Endoscopy • Tests for detection of H.pylori • Invasive: a) Rapid Urease - 80-95% / 95-100% b) Histology - 80-90% / > 95% c) Culture 2. Non-invasive: a) Serology - >80/>90 % b) Urea breath test - >90/>90 %

  9. Research question • What is the prevalence and effect of Helicobacter pylori infection in/on NSAID (including ASA) induced gastroduodenal damage?

  10. Previous Research Studies? • Kamada T et al; Endoscopic characteristics and Helicobacter pylori infection in NSAID-associated gastric ulcer. J Gastroenterol Hepatol. 2006 Jan;21(1 Pt 1):98-102 • Zapata-Colindres JC et al; The association of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic ulcer disease; Can J Gastroenterol. 2006 Apr;20(4):277-80 • Ootani H et al; Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding peptic ulcers in Japan; J Gastroenterol. 2006 Jan;41(1):41-6 • Okan A et al;Relationship between non-steroidal anti-inflammatory drug use and Helicobacter pylori infection in bleeding or uncomplicated peptic ulcers: A case-control study; J Gastroenterol Hepatol. 2003 Jan;18(1):18-25

  11. METHODS • Retrospective study • Total of 965 charts reviewed • 345 subjects selected for the study • Variables: Age, Gender, Medical illnesses, Status- NSAID/ H.Pylori / both, severity of gastric damage, PPI status, Endoscopy- indication and results. • SPSS version 17.0

  12. METHODS • Inclusion criteria: • Age : 21- 90yrs • On NSAIDs at the time of endoscopy • H. pylori test positivity • Both • Exclusion criteria: • On Steroids • Gastrointestinal malignancy • Gastric Bypass surgery • Inflammatory bowel disease

  13. METHODS • Grades of GI damage:

  14. METHODS • Rapid Urease Detection • Immunohistochemistry • Biopsy

  15. DATA ANALYSIS

  16. DATA ANALYSIS

  17. DATA ANALYSISMales

  18. DATA ANALYSISFemales

  19. DATA ANALYSISAge and NSAIDs

  20. DATA ANALYSISAge and Helicobacter pylori

  21. DATA ANALYSISMedical Illnesses

  22. DATA ANALYSISMost common complaint

  23. NSAIDs H. pylori Both

  24. NSAID Users- Not on PPI NSAID users- On PPI

  25. RESULTS • 2/3rd of subjects : 51-80yrs • 60% of subjects: Females • Males: 77% NSAID users • Females: 87% NSIAD users • Prevalence of H.pylori is highest between 71-80yrs • Most common co-morbid condition- HTN • Back pain and OA- about 8% of subjects • MC indication for upper GI endoscopy- Abdominal pain ( 20%)

  26. RESULTS (contd..) 9. Grade III GI damage among NSAID users (H.pylori –ve) : 25.8% 10. Grade III GI damage among Non NSAID users with H.pylori +ve : 29.1% 11. Grade III GI damage among NSAID users with H.pylori +ve : 29.8% 12. Grade III GI damage : NSAID users (on PPi) - 20.8%; NSAID users (not on PPi) - 31.8%

  27. CONCLUSIONS • H.Pylori: Increases with Age • H.pylori infection: Males> Females • NSAIDs: Increased use among elderly females • Gastric damage: Highest grade 3 among NSAID users with H.pylori infection • PPIs are beneficial with NSAIDs

  28. LIMITATIONS • Retrospective study • Single community hospital • Duration of NSAID intake • Lead time bias • Confounding factors

  29. THANK YOU !!!!!

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