Helicobacter pylori infection and the risk of upper gastrointestinal bleeding in low dose aspirin users: systematic review and meta‐analysis

Abstract

Objective: To determine whether the risk of upper gastrointestinal bleeding in patients taking low dose aspirin (≤ 325 mg/day) is increased in people with Helicobacter pylori infections. Study design: A systematic search for all publications since 1989 (when H. pylori was named) using search term equivalents for “upper gastrointestinal haemorrhage” and “aspirin”. Articles were assessed individually for inclusion of data on H. pylori infection, as not all relevant papers were indexed with this term. Data that could be pooled were then subjected to meta‐analysis, using a random effects model. Data sources: MEDLINE, Embase, Scopus, the Cochrane Library. Data synthesis: Of 7599 retrieved publications, reports for seven case–control studies contained data suitable for meta‐analysis; four were deemed high quality on the Newcastle–Ottawa scale. Upper gastrointestinal haemorrhage was more frequent in aspirin users infected with H. pylori than in those who were not (odds ratio [OR], 2.32; 95% CI, 1.25–4.33; P = 0.008). The heterogeneity of the studies was significant (Q = 19.3, P = 0.004; I2 = 68.9%, 95% CI, 31.5–85.9%), but the pooled odds ratio was similar after removing the two studies that contributed most to heterogeneity (OR, 2.34; 95% CI, 1.56–3.53; P < 0.001). The number needed to treat to prevent one bleeding event annually was estimated to be between 100 and more than 1000. Conclusions: The odds of upper gastrointestinal bleeding in patients taking low dose aspirin is about twice as great in those infected with H. pylori. Testing for and treating the infection should be considered in such patients, especially if their underlying risk of peptic ulcer bleeding is already high.

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

“…Of course, the significance of LDA‐induced PUD lies largely in its complications, such as hemorrhage, which has an annual risk nearer to 1% . Thus, the number needed to treat to prevent one LDA ulcer bleed annually by H. pylori eradication will be at least an order of magnitude higher than our estimate for endoscopic ulcers.…”

“…A recent meta-analysis found H. pylori to enhance the risk of peptic ulcer bleeding in LDA users. 9 However, its effect on the baseline risk of PUD in this population has not yet been established. In alignment with this, current guidelines are ambivalent about the need for H. pylori testing and eradication in LDA users to protect against PUD.…”

“…A recent meta‐analysis found H. pylori to enhance the risk of peptic ulcer bleeding in LDA users . However, its effect on the baseline risk of PUD in this population has not yet been established.…”

Small Intestinal Mucosal Injury not Associated with Acute Gastrointestinal bleeding Induced by Aspirin: a retrospective observational study

“…But their interaction in peptic ulcer disease is controversial with respect to the bene ts and risks of radical treatment of H. pylori before aspirin use, the totality of evidence remains incomplete. Most current studies supported that H. pylori infection combined with aspirin increased the risk of upper GI ulcer disease [11][12][13][14]. A few studies had linked H. pylori to an increased risk of aspirin-induced intestinal lesions.…”

Low dose aspirin, H. pylori infection, and the risk of upper gastrointestinal bleeding

“…The systematic review and meta‐analysis article published in this issue of the MJA 7 includes evidence from several new studies involving a total of 1172 patients from Europe and Japan with upper gastrointestinal bleeding, including seven case–control studies. Ng and Yeomans conclude that H. pylori infection (detected with the urea breath test or serology) increased the odds of gastrointestinal bleeding in low dose aspirin users by a factor of 2.32 (95% CI, 1.25–4.33).…”