Effects of Helicobacter pylori Infection on Long-term Risk of Peptic Ulcer Bleeding in Low-Dose Aspirin Users

Background & AimsCurrent 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.MethodsIn 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.ResultsThe 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).ConclusionsThe 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.