title: Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin.
abstract: BACKGROUND
  Aspirin is valuable for preventing vascular events, but information about ulcer frequency is necessary to inform risk-benefit decisions in individual patients.
  
  
  OBJECTIVE
  To determine ulcer prevalence and incidence in a population representative of those given aspirin therapy and evaluate risk predictors.
  
  
  METHODS
  Patients taking aspirin 75-325 mg daily were recruited from four countries. Exclusions included use of gastroprotectant drugs or other non-steroidal anti-inflammatory drugs. We measured point prevalence of endoscopic ulcers, after quantitating dyspeptic symptoms. Incidence was assessed 3 months later in those eligible to continue (no baseline ulcer or reason for gastroprotectants).
  
  
  RESULTS
  In 187 patients, ulcer prevalence was 11% [95% confidence interval (CI) 6.3-15.1%]. Only 20% had dyspeptic symptoms, not significantly different from patients without ulcer. Ulcer incidence in 113 patients followed for 3 months was 7% (95% CI 2.4-11.8%). Helicobacter pylori infection increased the risk of a duodenal ulcer [odds ratio (OR) 18.5, 95% CI 2.3-149.4], as did age >70 for ulcers in stomach and duodenum combined (OR 3.3, 95% CI 1.3-8.7).
  
  
  CONCLUSIONS
  Gastroduodenal ulcers are found in one in 10 patients taking low-dose aspirin, and most are asymptomatic; this needs considering when discussing risks/benefits with patients. Risk factors include older age and H. pylori (for duodenal ulcer).
authors.affiliation: Western Hospital, Department of Medicine, University of Melbourne, Melbourne, and University of Western Sydney, Sydney, Australia. n.yeomans@uws.edu.au
authors.forename: N D
authors.initials: ND
authors.lastname: Yeomans
authors.forename: A I
authors.initials: AI
authors.lastname: Lanas
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
authors.forename: A B R
authors.initials: AB
authors.lastname: Thomson
authors.forename: R
authors.initials: R
authors.lastname: Daneshjoo
authors.forename: B
authors.initials: B
authors.lastname: Eriksson
authors.forename: S
authors.initials: S
authors.lastname: Appelman-Eszczuk
authors.forename: G
authors.initials: G
authors.lastname: Långström
authors.forename: J
authors.initials: J
authors.lastname: Naesdal
authors.forename: P
authors.initials: P
authors.lastname: Serrano
authors.forename: M
authors.initials: M
authors.lastname: Singh
authors.forename: M M
authors.initials: MM
authors.lastname: Skelly
authors.forename: C J
authors.initials: CJ
authors.lastname: Hawkey
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013276:Stomach Ulcer / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin