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

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 Helicobacter 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 (OR) with 95% confidence intervals (CI) for the risk of LDA ulcers in Helicobacter pylori-positive vs. -negative individuals were 1.68 (95%CI 1.40-2.02) and 1.65 (95%CI 1.29-2.08) under fixed- and random-effects models, respectively. Heterogeneity among studies was minimal (I2 = 26.9%). After adjusting for the protective effects of antisecretory drugs, the OR increased to 1.94 (95%CI 1.54-2.46). This analysis suggests Helicobacter 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 Helicobacter pylori in LDA users, particularly those at higher risk of developing for peptic ulcers.