Helicobacter pylori and risk of upper gastrointestinal bleeding among users of selective serotonin reuptake inhibitors

Abstract

Background. A number of studies have reported a possible association between use of selective serotonin reuptake inhibitors (SSRIs) and serious upper gastrointestinal bleeding (UGB). We conducted this case–control study to assess if Helicobacter pylori (H. pylori) potentiates the risk of serious UGB in SSRI users. Material and methods. A population-based case–control study was conducted in the county of Funen, Denmark. Cases were 53 SSRI users with serious UGB whose H. pylori status on their bleeding date could be established. Controls (n = 723) were selected among subjects who participated in a population H. pylori screening study, and who were users of SSRIs. Data on drug exposure and medical history were retrieved from a prescription database and the county's patient register. Confounders were controlled for by unconditional logistic regression. Results. H. pylori infection increased the risk of serious UGB in patients using SSRI with an adjusted odds ratio (OR) of 2.73 (95% confidence interval (CI), 1.17–6.36). The adjusted OR for serious UGB among users of non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA) were 3.91 (95% CI, 2.03–7.52) and 3.00 (95% CI, 0.94–9.54), respectively. Conclusion. H. pylori infection increases the risk of SSRI-related serious UGB.

Key Words::

• Complicated peptic ulcer
• Helicobacter pylori
• selective serotonin reuptake inhibitor, serious upper gastrointestinal bleeding

Acknowledgments

The University of Southern Denmark and The Region of Southern Denmark provided data free of charge.

Declaration of interest: JH has received research grants from Novartis, Nycomed, and Pfizer and has taught courses for the Association of the Danish Medicines Industry. The other authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.