pylori infection and asthma and allergy, although data are conflicting and need to be expanded. The relationship between H. pylori infection and peptic ulcer disease (PUD) and also peptic ulcer bleeding (PUB) has been extensively studied. A meta-analysis reported that the prevalence of PUD ranged worldwide between 0.1 and 4.7%, with an annual incidence ranging from 0.19 to 0.3%

[1]. The majority of studies have reported a decrease in selleck chemicals the incidence and/or prevalence of PUD over time, presumably due to a decrease in H. pylori-associated PUD. H. pylori was initially responsible for up to 95% of all gastroduodenal ulcers, but more recent studies reported that the prevalence of H. pylori in patients with PUD ranged from 36 to 73%, depending on ethnicity, geographic, and socioeconomic factors [2]. A compilation of 71 original studies, including 8496 patients, found a mean 72% prevalence of H. pylori infection in PUB [3]. The association between H. pylori infection and PUB was previously studied in a meta-analysis that confirmed that H. pylori infection increased the risk of ulcer bleeding (OR 1.79) [4]. As a consequence of the introduction of potent acid inhibitors and eradication of H. pylori, Everolimus cell line a rapid decrease in both incidence and mortality of PUB was expected. However, although

most studies confirm such a decrease, the rate of hospitalization because of PUB decreases only slowly[5]. H. pylori resistance rates to antibiotics vary even in different regions of the same country. Effective H. pylori eradication reduces the rate of ulcer recurrence. Therefore, it is plausible that H. pylori eradication

also prevents recurrence of ulcer bleeding. However, the efficacy of eradication for the prevention of recurrent bleeding from peptic ulcer has not been completely established. A prospective, long-term study included 1000 patients with previous PUB, 41% of them had previously used an NSAID and none received a PPI or NSAID during follow-up [6]. Peptic ulcer rebleeding virtually did not occur after H. pylori eradication (0.5%). The authors concluded that maintenance of antisecretory therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding medchemexpress in H. pylori-eradicated patients. In daily clinical practice, concomitant H. pylori infection and NSAID and/or aspirin use are common, in particular, in elderly. Both H. pylori infection and NSAID use are independent risk factors for the development of PUD and associated bleeding. There is a synergistic effect for the development of GI bleeding when these factors are both present [7]. Although H. pylori is frequently reported as a risk factor for upper GI bleeding in aspirin users, the real effect of H. pylori eradication on reducing the risk of bleeding remains unclear. The Maastricht guideline advocates an H.