title: Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users.
abstract: OBJECTIVE
  Current guidelines recommend testing for Helicobacter pylori infection among users of low-dose aspirin (ASA) who are at high risk for developing ulcers. However, it is not clear whether this strategy affects long-term risk of ulcer bleeding. We assessed the utility of testing ASA users with a high risk of ulcer bleeding for H pylori infection.
  
  
  METHODS
  In a prospective study, we recruited 3 cohorts of ASA users (≤160 mg/day). The first group included H pylori-positive users of ASAs with bleeding ulcers in whom the infections were eradicated (n = 249). They resumed ASA after ulcer healing and H pylori eradication. The second group included H pylori-negative (past and present) users of ASA who developed bleeding ulcers (n = 118). They received enteric-coated ASA after ulcer healing. The average-risk cohort included new users of ASA without a history of ulcers (n = 537). None of the subjects received regular treatment with anti-ulcer drugs. The primary end point was ulcer bleeding with ASA use in 5048 patient-years of follow-up evaluation.
  
  
  RESULTS
  The incidence of ulcer bleeding (per 100 patient-years) in the H pylori-eradicated cohort (0.97; 95% confidence interval [CI], 0.53-1.80) did not differ significantly from that of the average-risk cohort (0.66; 95% CI, 0.38-0.99). The H pylori-negative cohort had a high incidence of recurrent bleeding (5.22; 95% CI, 3.04-8.96) (incidence rate ratio, 8.52; 95% CI, 4.29-16.95 vs the average-risk cohort).
  
  
  CONCLUSIONS
  The long-term incidence of recurrent ulcer bleeding with ASA use is low after H pylori infection is eradicated. ASA users without current or past H pylori infections who develop ulcer bleeding have a high risk of recurrent bleeding. Tests for H pylori infection can be used to assign high-risk ASA users to groups that require different gastroprotective strategies.
authors: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong. fklchan@cuhk.edu.hk
authors: Francis K L
authors: FK
authors: Chan
authors: Jessica Y L
authors: JY
authors: Ching
authors: Bing Yee
authors: BY
authors: Suen
authors: Yee Kit
authors: YK
authors: Tse
authors: Justin C Y
authors: JC
authors: Wu
authors: Joseph J Y
authors: JJ
authors: Sung
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005343:Fibrinolytic Agents; D001241:Aspirin