Aspirin doubles bleeding risk for people with common gut bacteria, researchers say

The presence of a common stomach bacterium can more than double the risk of upper gastrointestinal bleeding in patients taking daily low-dose aspirin, according to a meta-analysis by Australian researchers.
 
Published in the Medical Journal of Australia, ‘Helicobacter pylori infection and the risk of upper gastrointestinal bleeding in low dose aspirin users: systematic review and meta-analysis’ conducted a systematic search for all relevant publications since 1989 (when the bacteria was named).
 
Co-author Dr Justin Ng from Peninsula Health told newsGP the research studied the effect of having Helicobacter pylori infection on the risk of upper gastrointestinal (UGI) bleeding in patients who take low-dose aspirins – a daily dose of 325 mg.


Dr Justin Ng says aspirin stops platelets from coming together and therefore can make peptic ulcers bleed even more.

Dr Ng, who conducted the research as part of his medical studies at the University of Melbourne, said it was the first study of its kind.
 
‘The reason why we looked at [it] is that the current guidelines in the US and Europe … they do recommend that we should be testing patients prior to starting patients on low-dose aspirin, for Helicobacter pylori,’ he said.
 
‘Except the evidence that they have for that recommendation … is low … because … [in the research they] looked at the risk of upper gastrointestinal bleeding and Helicobacter pylori infection in the context of Nonsteroidal anti-inflammatory drugs (NSAIDs), rather than aspirin per se.
 
‘There has been no meta-analysis that looked at this topic before.’
 
Dr Ng said aspirin had similar properties to NSAID, but it was different from it.
 
‘Aspirin also stops platelets from coming together and therefore can make peptic ulcers bleed even more,’ he said.
 
Helicobacter pylori is a gram negative bacillus that has naturally colonised the human stomach for at least 50,000 years. Usually acquired in childhood, it colonises the gastric mucosa of about 50% of the world’s population at some time in their life. In westernised countries, the infection has a prevalence of approximately 30%.
 
As part of the study, the researchers examined seven papers with a total of 1172 patients.
 
‘It found the odds of having an UGI is doubled if you take the low-dose aspirin and you have the Helicobacter pylori infection,’ Dr Ng said.
 
Dr Ng and co-author Emeritus Professor Neville Yeomans at the University of Melbourne said the cost–benefit balance of testing for and treating the bacterium may be insufficient to permit recommending this approach for all patients receiving aspirin on a long-term basis.
 
'However, the evidence is sufficient to warrant considering eradication of the infection in patients who are at high risk of ulcer complications because of comorbid conditions,’ they said.

Helicobacter pylori Medical Journal of Australia Peninsula Health University of Melbourne