Secondary prevention of upper gastrointestinal bleeding in low dose aspirin users infected with Helicobacter pylori

Background: Aspirin even at low dose (100 mg) can increase the risk of upper gastrointestinal bleeding. It is usual to use low dose aspirin for cardiovascular prophylaxis. We hypothesized that Helicobacter pylori eradication is as effective as omeprazole maintenance therapy for secondary prevention of bleeding in those who take low dose aspirin and are positive for Helicobacter pylori. Methods: To compare the effect of Helicobacter pylori eradication and omeprazole maintenance therapy in upper gastrointestinal bleeding sixty-two patients taking low dose aspirin for cardiovascular prophylaxis were prospectively followed for 6 months. Upper gastrointestinal bleeding was confirmed by endoscopy. Ulcers healed with 2 months treatment of 20 mg omeprazole daily. Aspirin was withheld during this 2 months. Low dose aspirin was given again after that. Thirty-one patients underwent Helicobacter pylori eradication with amoxicillin 1 g bid, metronidazole 500 mg bid, and bismuth subcitrate 240 mg bid for 2 weeks and did not receive omeprazole any more, and in thirty-one patients only omeprazole was given for 6 months. Results: Gastrointestinal bleeding occurred in 3 patients. Two (6%) were in the eradication and one (3%) was in the omeprazole group. The difference was not statis-tically significant. Conclusion: Helicobacter pylori eradication is equivalent to omeprazole treat-ment in secondary prevention of upper gastrointestinal bleeding in patients who take low dose aspirin and are infected with Helicobacter pylori.