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Current guidelines recommend testing for Helicobacter pylori infection among users of low-dose aspirin who are at high risk for developing ulcers. However, it is not clear whether this strategy affects long-term risk of ulcer bleeding. Dr Francis Chan and colleagues from Hong Kong assessed the utility of testing low-dose aspirin users with a high risk of ulcer bleeding for H pylori infection. In a prospective study, the team recruited 3 cohorts of low-dose aspirin users. The first group included H pylori–positive users of low-dose aspirins with bleeding ulcers in whom the infections were eradicated. They resumed low-dose aspirin after ulcer healing and H pylori eradication.  | | H pylori–negative cohort had a high incidence of recurrent bleeding | | Gastroenterology |
The second group included H pylori–negative users of low-dose aspirin who developed bleeding ulcers. They received enteric-coated low-dose aspirin after ulcer healing. The average-risk cohort included new users of low-dose aspirin without a history of ulcers. The team reported that none of the subjects received regular treatment with anti-ulcer drugs. The research team's primary end point was ulcer bleeding with low-dose aspirin use in 5048 patient-years of follow-up evaluation. The researchers found that the incidence of ulcer bleeding in the H pylori–eradicated cohort did not differ significantly from that of the average-risk cohort. The team noted that H pylori–negative cohort had a high incidence of recurrent bleeding. Dr Chan's team concludes, "The long-term incidence of recurrent ulcer bleeding with low-dose aspirin use is low after H pylori infection is eradicated." "Low-dose aspirin 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 low-dose aspirin users to groups that require different gastroprotective strategies."
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