Helicobacter pylori eradication protects against aspirin-associated peptic ulcer bleeding

Helicobacter pylori eradication protects against aspirin-associated peptic ulcer bleeding

A new study led by experts at the University of Nottingham found that the risk of stomach bleeding caused by long-term aspirin use can be reduced with a short course of antibiotics, potentially improving the safety of aspirin when used to prevent heart attacks. Strokes and possibly some cancers.

The results of the .HEAT (Helicobacter pylori Eradication Aspirin) study, led by Professor Chris Hawkey of the University of Nottingham School of Medicine and the Nottingham Digestive Diseases Center and funded by the National Institute for Health and Care Research Health Technology Assessment Program, are published in The Lancet.

Aspirin in low doses is a very useful preventive medication in people at high risk of stroke or heart attack. However, in rare cases, internal ulcer bleeding may occur.

By thinning the blood, aspirin causes stomach ulcers to bleed. These ulcers can be caused by a specific type of bacteria, Helicobacter pylori.

The University of Nottingham's Simple Trials for Academic Research (STAR) team investigated whether a short course of antibiotics to remove these bacteria would reduce the risk of bleeding in aspirin users.

The .HEAT (Helicobacter pylori Eradication Aspirin) study was a very large study carried out in 1,208 general practices in the UK. It was a real-world study that used clinical data routinely stored in physician and hospital records rather than bringing patients back for follow-up visits.

The team enrolled 188,875 patients taking aspirin and 30,166 volunteered and took part in the study. Those who tested positive for H. pylori were randomly assigned to receive antibiotics or placebo (dummy tablets) and followed up for up to 7 years.

In the first two and a half years, those treated with antibiotics were less likely to be hospitalized for ulcer bleeding than those given dummy tablets (6 versus 17). The protection came quickly: for those who received placebo (a dummy treatment), the first hospitalization for ulcer bleeding occurred after 6 days, compared to 525 days after antibiotic treatment.

Over a longer period of time, protection seemed to disappear. However, the overall rate of hospitalizations for peptic ulcer bleeding was lower than expected, and this is consistent with other evidence that peptic ulcer disease is declining. The risks for people already taking aspirin are low. The risks are higher when people first start taking aspirin, when H. pylori is being screened for and treatment is probably worth it.

Aspirin has many benefits in terms of reducing the risk of heart attacks and strokes in people at increased risk. There is also evidence that it may slow certain types of cancer. The .HEAT study is the largest study of its kind conducted in the UK and we are pleased that the results have shown that ulcer bleeding can be significantly reduced after a week of antibiotic treatment. The long-term implications of the results are encouraging for safe prescribing.”

Chris Hawkey, Professor, School of Medicine, University of Nottingham

The results of the study will be presented at the UEG (United European Gastroenterology) scientific meeting in Vienna, where they won a top abstract prize worth 10,000 euros. The STAR team intends to use the prize to sponsor a competition to support collaboration with a research team that would like to use the STAR methodology.

Source:

University of Nottingham

Reference:

Hawkey, C., et al. (2022) A large clinical trial shows how the risk of occasional stomach bleeding caused by regular aspirin use can be reduced. The lancet. doi.org/10.1016/S0140-6736(22)01843-8.

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