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Title: Helicobacter pylori and low-dose aspirin ulcer risk: A meta-analysis.
Authors: Sarri, Gino L;Grigg, Sam E;Yeomans, Neville D
Affiliation: Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Office for Research, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Mar-2019
EDate: 2018-12-17
Citation: Journal of gastroenterology and hepatology 2019; 34(3): 517-525
Abstract: 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. 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. 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). 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.
DOI: 10.1111/jgh.14539
ORCID: 0000-0001-7803-3169
PubMed URL: 30408229
Type: Journal Article
Subjects: Helicobacter pylori
peptic ulcer
Appears in Collections:Journal articles

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