Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin.
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).
Yeomans
N D
ND
Western Hospital, Department of Medicine, University of Melbourne, Melbourne, and University of Western Sydney, Sydney, Australia. n.yeomans@uws.edu.au
Lanas
A I
AI
Talley
N J
NJ
Thomson
A B R
AB
Daneshjoo
R
R
Eriksson
B
B
Appelman-Eszczuk
S
S
Långström
G
G
Naesdal
J
J
Serrano
P
P
Singh
M
M
Skelly
M M
MM
Hawkey
C J
CJ
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
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin