Helicobacter pylori infection in rheumatoid arthritis: effect of drugs on prevalence and correlation with gastroduodenal lesions

C. Kelly and V. Saravanan

Department of Rheumatology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK

SIR, We read with interest the detailed and thorough report by Ishikawa et al. on the correlation of Helicobacter pylori with endoscopic lesions in the upper gastrointestinal tract of patients with rheumatoid arthritis (RA) on non-steroidal anti-inflammatory drugs (NSAIDs) [1]. They found no link between endoscopically visualized pathology and the presence of Helicobacter, except for a reduction in gastro-oesophageal reflux in colonized individuals. Sixty of their 184 patients were symptomatic and the prevalence of Helicobacter in these patients was identical to that in the group overall at 61%. Fifty-three patients were found to have peptic ulcers, of which only 11 were in the duodenum, although Helicobacter was present in eight of these patients. However, the data do not allow calculation of the number and site of ulcers occurring in symptomatic individuals.

We recently performed a prospective endoscopic study of 100 RA patients with dyspepsia to investigate the factors contributing to symptoms. We found that the prevalence of Helicobacter was no different from that in an age-matched control group with osteoarthritis, but that the coexistence of NSAID consumption and Helicobacter colonization increased the chance of finding gastroduodenal ulceration highly significantly in RA patients [2]. There was no significant effect of oral steroids or disease-modifying drugs on ulceration. We feel that eradication of Helicobacter is appropriate in the presence of endoscopically visualized ulceration, especially in the duodenum.

We wonder if it would be possible to see the details of the endoscopic findings in symptomatic patients in the study of Ishikawa et al., with reference to their Helicobacter status? If there is an association between duodenal ulceration and Helicobacter status in these patients, it would justify endoscopy in dyspeptic RA patients. If the data fail to confirm our findings, a logical alternative approach may be the use of proton pump inhibitors in all NSAID-treated RA patients with dyspepsia, reserving the use of endoscopy for iron deficiency anaemia or persistent gastrointestinal symptoms.

Notes

Correspondence to: C. Kelly. E-mail: kelly6.family{at}breathemail.net Back

References

  1. Ishikawa N, Fuchigami T, Matsumoto T et al. Helicobacter pylori infection in rheumatoid arthritis: effect of drugs on prevalence and correlation with gastroduodenal lesions. Rheumatology 2002;41:72–7.[Abstract/Free Full Text]
  2. Grigoriadou S, Quraishi A, Saravanna S, Saravanan V, Heycock C, Kelly C. What effect does Helicobacter pylori infection have on the risk of peptic ulceration in patients receiving NSAIDs for rheumatoid arthritis? Eur J Intern Med 2002;13:269–73.[CrossRef][Medline]
Accepted 1 July 2002





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