Ulcer bleeding and perforation: non-steroidal anti-inflammatory drugs or Helicobacter pylori.

Non-steroidal anti-inflammatory drug (NSAID)-exposure increases the risk for ulcer perforation by a factor of 5–8. Recent data from Norway indicate that NSAID exposure is more common in gastric than in prepyloric, pyloric and duodenal perforation. Twenty to 40% of patients with gastric perforation have used NSAIDs; attributable risks are not published. The risk for ulcer bleeding is increased by a factor of 3–5 in NSAID users, with similar effects for stomach and duodenum. NSAID exposure accounts for 20–35% of ulcer bleedings. There is little knowledge about the role of Helicobacter pylori in ulcer complications, a limited importance of the bacteria is indicated in the etiology of both perforation and bleeding. Ulcer complications have a multifactorial origin. NSAIDs account for a limited part of the events. H. pylori infection may play a still undocumented role. Smoking, alcohol and aspirin are other important causal factors.