Ulcer Patients Tolerate Aspirin Therapy Following Antibiotics
March 28, 2001 -- Most of the 80 million aspirin tablets Americans take each day are used not for headaches, but to reduce the risk of heart attacks and strokes. But even low-dose aspirin therapy can be problematic for people with a history of bleeding ulcers, because aspirin use increases the risk of rebleeding.
It may be possible to minimize that risk in some patients, however, with a simple, one-week course of antibiotics. Researchers from Hong Kong's Prince of Wales Hospital found that ulcer patients treated with antibiotics to kill a common stomach bacteria, known as Helicobacter pylori (H. pylori), were able to tolerate aspirin therapy as well as those who were treated with expensive antiulcer drugs. They reported their findings in the March 29 issue of The New England Journal of Medicine.
As many as one in 10 Americans develop ulcers in the lining of the stomach or duodenum, known as a peptic ulcers, at some point in life, and the risk increases with age. H. pylori infection is widely believed to be responsible for a large majority of these ulcers -- as many as 80% of stomach ulcers and more than 90% of duodenal ulcers, according to figures from the National Digestive Diseases Information Clearinghouse.
Because patients who have had bleeding ulcers tend to be older, as are those at increased risk for heart attacks and strokes, the issue of whether these patients can take daily aspirin therapy is critical. Many doctors who prescribe aspirin therapy to patients with a history of bleeding ulcers also prescribe daily use of antiheartburn, antiulcer drugs like Prilosec.
"[Prilosec] requires daily compliance and is very expensive," study author Francis K.L. Chan, MD, tells WebMD. "We were looking for alternative ways to prevent recurrent bleeding that were easier for the patient and more cost effective."
Chan and colleagues screened approximately 900 bleeding ulcer patients who were regular users of low-dose aspirin and other nonsteroidal anti-inflammatory drugs (or NSAIDs) for H. pylori infection. They found that 58% of aspirin users and half of other NSAID users had the infection. After the ulcers were healed using Prilosec, roughly half of those with the bacterial infection were treated with a one-week course of antibiotic therapy to eradicate the H. pylori and the other half continued on Prilosec.
After six months, the risk of recurrent ulcers was 2% in aspirin patients given antibiotics, compared to 1% in those still taking Prilosec. This result, it's important to point out, did not work with other NSAIDS, in this case naproxen (drugs such as Aleve), but just aspirin. In fact, the risk of recurrent ulcers was high among people taking other NSAIDS compared to those still taking Prilosec.
"These findings show that if you have H. pylori infection and you require aspirin and are at risk of developing peptic ulcer disease, [antibiotics] can be as effective as giving antiulcer agents," Chan says. "For other nonsteroidal anti-inflammatory drugs, the story is more complicated, however. For a chronic NSAID user with a history of ulcer disease, the best treatment is still an antiulcer agent like [Prilosec]."