A meta-analysis of randomized trials (five studies and 939 patients) evaluating whether eradication of H. pylori prevented

peptic ulcer in NSAIDs users suggested that eradication reduced the incidence of peptic ulcer in NSAID-naïve patients (OR 0.26; 95% CI 0.14–0.49), but not in previously treated patients (OR 0.95, 95% CI 0.53–1.72).12 The fact that eradication appears to be effective when performed in NSAID-naïve patients is consistent. In a study of the effect of H. pylori eradication and/or PPI use among patients who had bled while receiving aspirin, H. pylori eradication was comparable to maintenance treatment Y 27632 with PPI for the prevention of recurrent ulcer bleeding with LDA, unlike non-aspirin NSAIDs (annual rate of 3.8% in the eradication group vs 1.8% in the PPI group).18 In another study with a median follow up of 12 months, rebleeding occurred in 1 of the 62 patients (1.6%) receiving maintenance PPI after H. pylori eradication and in 9 of the 61 patients (14.8%) with eradication only.19 To prevent recurrent ulcer bleeding with LDA, PPIs seem to be superior to eradication

only. We showed a significant inverse association of co-treatment with HMG-Co GS1101 A reductase inhibitors (statins) or angiotensin type 1 receptor (AT1R) blockers (ARBs) with peptic ulcer and bleeding among patients taking LDA. ARBs (adjusted OR 0.24, 95% CI 0.06–0.91) and statins (0.20, 0.05–0.76) were significantly associated with peptic ulcer bleeding, and co-treatment with an ARB (0.30, 0.14–0.63) was significantly associated with peptic ulcer.9 ARBs are reported to protect gastric blood flow by partially inhibiting sympathoadrenal medchemexpress discharge and angiotensin II-mediated vasoconstriction.20,21 Additionally, ARBs block the inflammatory cascade of tumor necrosis factor (TNF-α) and intracellular adhesion molecule 1 (ICAM-1) mediating neutrophil adherence within the gastric microcirculation.22–25

Statins have also been reported to have antiulcer effects by reducing gastric acidity and the formation of NSAID- and ethanol-induced gastric lesions. Statins have anti-inflammatory and anti-oxidant properties by their inhibition of neutrophil activity, reduction of oxidative stress, and maintenance of vascular integrity.26–28 However, it still remains to be determined whether statin therapy, as well as ARB use, is correlated with peptic ulcer or NSAID-induced mucosal injuries in humans. Aspirin produces its antithrombotic effect via irreversible acetylation of a serine in COX-1 in platelets, which abolishes the production of thromboxane A2 for platelet aggregation.29 There is genetic diversity within the COX-1 locus, and at least nine different single nucleotide polymorphisms (SNPs) have been identified.