Management of nonsteroidal anti-inflammatory drug–related peptic ulcer bleeding

Nonsteroidal anti-inflammatory drugs (NSAIDs) have superseded Helicobacter pylori infection as the most important cause of peptic ulcer bleeding. Eradication of H. pylori in NSAID users will not affect ulcer healing. In high-risk patients with a history of ulcer bleeding, curing H. pylori infection alone without acid suppression has substantially reduced the risk of rebleeding caused by low-dose aspirin but not nonaspirin NSAIDs. In a study comparing the safety profile of misoprostol in combination with NSAID against nabumetone in high-risk patients with a history of ulcer bleeding, both strategies were unable to confer significant protection against the risk of rebleeding.