The nonsteroidal anti-inflammatory drugs controversy.

The relationship between NSAIDs and H. pylori as risk factors for the development of peptic ulcer is complex and controversial. In the case of duodenal ulcers in NSAID users, there now is enough information to suggest that eradication of H. pylori usually is worthwhile. In the stomach, however, there is some evidence that ulcers heal faster and are no more likely to reappear if the infection is left alone, provided that patients continue to take an NSAID. Why this situation should be so is unclear. Possibilities include greater efficacy of antisecretory agents, a smaller inhibition of prostaglandin production, and a blunted apoptotic response in patients who are infected with H. pylori and take NSAIDs.