| セッション情報 |
International Forum 1(Gastrointestinal tract) 4.Prevention of NSAIDs-gastropathy
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| タイトル |
IF1-4-I (Keynote lecture) Helicobacter pylori and NSAIDs induced gastric ulcer: Japanese Guideline
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| 演者 |
Kazunari Murakami（Oita UniversityOitaJapan） |
| 共同演者 |
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| 抄録 |
A recent metaanalysis by Huang et al． clarified that H． pylori infection and NSAIDs are important factorsfor peptic ulcer． The results showed that the risk for ulcer in NSAID （+） ／H． pylori （+） patients was 61.1-fold higher when compared to NSAID （-）／H． pylori （-） patientswith each factor increasing the risk byabout 20-foldthus suggesting a synergistic effect． From the viewpoint of etiologysome gastric ulcers de-tected in patients on NSAID therapy may actually be caused by H． pyloribut it is difficult to differentiateNSAID-induced gastric ulcer from H． pylori-induced gastric ulcer． While levels of gastric acid secretionhave increased among Japanesethey are still lower when compared to Westerners．Several studies have investigated the effects of H． pylori eradication on ulcer healingSome of them con-cluded that H． pylori infection did not affect the treatment of ulcer in patients who continued to takeNSAIDs． And one of them reported that H． pylori eradication actually lowered the healing rate of gastriculcersBecause there have been no studies finding that H． pylori eradication facilitates healingH． pylorieradication is not recommended． As the dynamics of gastric acid secretion may affect gastric ulcer onsetand healingit is necessary to conduct a study in Japan．About the efficacy of H． pyloTi eradication in the prevention of NSAID-induced gastric ulcerametaanalysis concluded that ： （1） among all patients on NSAID therapyH． pylori eradication loweredthe prevalence of ulcer 1 （2） this was particularly marked in NSAID-nal’ve patients ； and （3） when com-pared to PPIsthe preventative effects of H． pylori eradication were inferiorAnother study found thatPPIs significantly suppress recurrent ulcer caused by low-dose aspirin following H． pylori eradication．Thereforewhen preventing recurrence of low-dose aspirin一induced ulcerH． pylori eradication and PPIadministration are recommended． ln Japannational health insurance does not cover procedures that pre-vent or lower the risk for NSAID-induced ulcer． When administering NSAIDs to patients with risk fac-torsit is desirable to administer antiulcer agents． |
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