Medical Health Encyclopedia

Who is at Risk for Ulcers from H. Pylori? Although H. pylori infection is very common, ulcers are very rare in children and only a minority of infected adults develops ulcers. Some known risk factors include smoking, alcohol use, having a relative who has had peptic ulcers, being male, and the presence of the cytotoxin-associated gene A (CagA). Experts are unable to determine, however, any single factor or group of factors that could determine which infected patients are most likely to develop ulcers.

Risk Factors for NSAID-Induced Ulcers

Between 15% and 25% of patients who have taken NSAIDs regularly will have evidence of one or more ulcers, but in most cases they are very small. Given the widespread use of these drugs, however, the total number of people with serious problems may be considerable. Long-term NSAID use can cause damage to the stomach and possibly the small intestine.

In April 2005, the FDA asked drug manufacturers of prescription NSAIDs to include with their products the same boxed warning used for the COX-2 inhibitor celecoxib (Celebrex). This boxed warning emphasizes an increased risk for cardiovascular events and gastrointestinal bleeding in people taking these drugs. The FDA also requested manufacturers of OTC NSAIDs to revise their labels to include more specific language concerning potential cardiovascular and gastrointestinal risks. Due to its proven heart benefits, aspirin was excluded from these labeling revisions

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High-Users of NSAIDs. Anyone who uses NSAIDs regularly is at risk for gastrointestinal problems. Even low-dose aspirin (81 mg) used to protect the heart may pose some risk (although lower than standard doses). In one study, over a four-year period, 4.5% of regular uses were hospitalized for GI bleeding. The highest risks, however, are in people who require long-term use of very high doses, notably people who suffer from arthritis, particularly rheumatoid arthritis. Others that have a high intake of NSAIDs, include, but are not limited to, people with chronic low back pain, fibromyalgia, and repetitive stress .