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

Abstract

Background and Aim Owing to wide‐spread use, low‐dose aspirin (LDA) produces a substantial amount of peptic ulcer disease. Current guidelines are ambivalent about the need for Helicobacter pylori eradication to protect against LDA ulcers. This study aimed to determine, through meta‐analysis, if (and by how much) infection alters the baseline risk of peptic ulcers during LDA therapy. Methods Literature screening was performed in MEDLINE and EMBASE from inception to May 2018. Original studies reporting prevalence or incidence of uncomplicated ulcers in LDA users were included. Ulcer endpoints needed to be specified separately, according to H. pylori infection status. Meta‐analysis was performed in MIX 2.0 Pro. Results Ten cross‐sectional studies and seven randomized controlled trials were included (n = 5964). The pooled odds ratios with 95% confidence intervals (CI) for the risk of LDA ulcers in H. pylori‐positive versus H. pylori‐negative individuals were 1.68 (95%CI 1.40–2.02) and 1.65 (95%CI 1.29–2.08) under fixed‐effects and random‐effects models, respectively. Heterogeneity among studies was minimal (I2 = 26.9%). After adjusting for the protective effects of antisecretory drugs, the odds ratios increased to 1.94 (95%CI 1.54–2.46). Conclusion This analysis suggests that H. pylori increases the risk of LDA ulcers by almost 70% in a population where some were taking proton pump inhibitors and/or other acid suppressants. Without antisecretory drugs, the risk almost doubles. Clinically, these findings may support the use of a test‐and‐treat approach to H. pylori in LDA users, particularly those already at higher risk of developing peptic ulcers.

Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO)

“…Furthermore, even in this consensus, there were no specific advices regarding non-aspirin antiplatelet agents or oral anticoagulants [86]. After these guidelines have been issued, two meta-analyses were published [87,88]. The former showed that H. pylori infection increased the risk of gastroduodenal ulcers during LDA therapy by approximately 70% (OR: 1.65; 95% CI: 1.29-2.08) [87].…”

“…After these guidelines have been issued, two meta-analyses were published [87,88]. The former showed that H. pylori infection increased the risk of gastroduodenal ulcers during LDA therapy by approximately 70% (OR: 1.65; 95% CI: 1.29-2.08) [87]. The latter found that the odds of UGIB in patients taking LDA was almost two-and-one-half times as frequent in H. pylori-positive (OR: 2.32; 95% CI: 1.25 -4.33) [88].…”

“…The interaction between H. pylori infection and antiplatelet therapy also remains controversial [5,78,[82][83][84][85][86][87][88], and randomized prospective studies are required. Finally, there is no evidence on the efficacy of gastroprotective drugs other than PPIs in preventing damage from antiplatelet agents [91][92][93][94][95][96][97][98][99][100][101].…”

Review: Helicobacter pylori and non‐malignant upper gastrointestinal diseases

“…Sarri et al performed a meta‐analysis aimed at risk assessment of PUD in low‐dose aspirin users with H pylori infection. The authors included 10 cross‐sectional studies and 7 randomized trials . H pylori infection increased the risk of PUD in case of low‐dose aspirin intake, by 70% in subjects taking acid‐suppressive drugs, and doubled the risk in people without antisecretory drugs.…”

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

“…Recently, new guidelines for cardiovascular diseases have been published, and extensive use of both antithrombotic and anticoagulant therapy is recommended [8]. In previous studies, it has been documented that NSAIDs result in a fourfold increased risk of bleeding from a peptic ulceration, while ASA and the presence of H. pylori double the risk [9]. With concurrent use of NSAIDs and H. pylori infection, there is an eightfold increased risk of ulcer bleeding [2].…”