Clinical Risk Factors for Gastroduodenal Ulcer in Romanian Low-Dose Aspirin Consumers

Abstract

Background. Aspirin use for cardiovascular or cancer prevention is limited due to its gastrointestinal side effects. Objective. Our prospective, observational case-control study aims to identify the predictive factors for ulcers in low-dose aspirin consumers (75–325 mg/day). Methods. The study included patients who underwent an upper digestive endoscopy and took low-dose aspirin treatment. Results. We recruited 51 patients with ulcer (ulcer group) and 108 patients with no mucosal lesions (control group). In univariate analysis, factors significantly associated with ulcers were male gender (p = 0.001), anticoagulants (p = 0.029), nonsteroidal anti-inflammatory drugs (p = 0.013), heart failure (p = 0.007), liver (p = 0.011) or cerebrovascular disease (p = 0.004), diabetes mellitus (p = 0.043), ulcer history (p = 0.044), and alcohol consumption (p = 0.018), but not Helicobacter pylori infection (p = 0.2). According to our multivariate regression analysis results, history of peptic ulcer (OR 3.07, 95% CI 1.06–8.86), cotreatment with NSAIDs (OR 8, 95% CI 2.09–30.58) or anticoagulants (OR 4.85, 95% CI 1.33–17.68), male gender (OR 5.2, 95% CI 1.77–15.34), and stroke (OR 7.27, 95% CI 1.40–37.74) remained predictors for ulcer on endoscopy. Conclusions. Concomitant use of NSAIDs or anticoagulants, comorbidities (cerebrovascular disease), and male gender are the most important independent risk factors for ulcer on endoscopy in low-dose aspirin consumers, in a population with a high prevalence of H. pylori infection.

Congestive Heart Failure and Upper Digestive Endoscopic Lesions

“…The consumption of gastro-toxic drugs (NSAIDs, LDA), was less frequent in patients with CHF, while anticoagulants were more frequent, as the international thera-peutic guideline recommends their use in treatment or secondary prevention of the underlying conditions. Among all questioned variable, the aggressive effect of antiplatelet therapy (LDA), in a vulnerable congestive gastric mucosa was supported by our present and past results, while the role of anticoagulants should be further investigated in larger studies [22]. It has been demonstrated that daily LDA consumption reduces the risk of cardiovascular diseases, however, it also associates adverse effects, mostly in the gastrointestinal tract.…”

Helicobacter pylori and low‐dose aspirin ulcer risk: A meta‐analysis

“…Selection bias, for individuals with active PUD, could further not be ruled out of three studies. 17,23,30 Despite these limitations, the results of a sensitivity analysis limited to only higher quality studies did not differ greatly from the complete analysis. Some potential confounding factors could not be reconciled in this analysis.…”

“…Two final studies enrolled individuals on long-term LDA (≥1 month), who were undergoing endoscopy for investigation of primarily gastrointestinal symptoms. 23,30 Mean LDA dose ranged from 100-160 mg daily in five cross-sectional studies 3,24,28,29,31 and was not reported in the remainder.…”

“…A second analysis included 13 studies (or subgroups within studies; n = 2702) that prohibited antisecretory drug use 3,[17][18][19][20][21]26,27,29,30 or demonstrated statistically comparable antisecretory drug use across H. pylori-positive and H. pylori-negative groups. 23,25,28 The pooled effect (fixed-effect) and heterogeneity were again similar to the complete analysis; however, the effect size was larger (OR 1.94, 95%CI 1.54-2.46; Q = 16.63, P = 0.16; I 2 = 27.83).…”

“…Most were of cross-sectional design, while the remainder were RCTs treated as cohort studies, as none directly address the primary aim. Ten studies 20,[22][23][24][25][26][28][29][30][31] were not conducted at a population level and may have also introduced participation bias. Selection bias, for individuals with active PUD, could further not be ruled out of three studies.…”