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Aspirin use doesn’t curb peptic ulcer healing

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients with aspirin-related peptic ulcers, ulcer healing rates are comparable after esomeprazole therapy with or without aspirin continuation, Taiwanese researchers report in an April 17th on-line paper in The American Journal of Gastroenterology.

In fact, the investigators suggest that “continuing low-dose aspirin plus a proton pump inhibitor is the best initial treatment for aspirin-related peptic ulcers.”

Dr. Ping-I Hsu of Kaohsiung Veterans General Hospital and colleagues note that aspirin is associated with upper gastrointestinal side effects including bleeding and non-bleeding peptic ulcers. However, it is also is widely used in the prevention of myocardial infarction or ischemic stroke.

Whether stopping aspirin use aids ulcer healing is not clear. To investigate, the team studied 178 patients. They were randomized to receive esomeprazole 40 mg daily with or without 100 mg of aspirin daily.

The 67 patients with Helicobacter pylori infection were treated with standard triple therapy. Use of corticosteroids was allowed in those for example with rheumatoid arthritis or COPD.

Unstable angina developed in one patient in the esomeprazole plus aspirin group and none of the patients in the esomeprazole group. No participants experienced acute myocardial infarction or ischemic stroke.

At 8 weeks, in an intention-to-treat analysis based on ulcer healing in all the patients who underwent follow-up endoscopy, the rate was 82.5% for esomeprazole alone and 81.5% with the combination.

Per protocol results were similar (83.1% versus 83.8%). Multivariate analysis showed that use of steroids was the only independent factor associated with the failure of ulcer healing (odds ratio, 5.6).

The researchers note that the results are informative, but the confidence interval on per protocol analysis was wide. This might mean that the aspirin group could have a healing rate more than 11% lower than the group not receiving aspirin.

Nonetheless, Dr. Hsu told Reuters Health by email, “Since continued use of aspirin during proton-pump inhibitor… therapy for aspirin-related peptic ulcer has no noticeable affect on peptic ulcer healing rates, patients on low-dose aspirin do not need to stop aspirin while undergoing treatment with a proton-pump inhibitor for peptic ulcer.”


Esomeprazole Alone Compared with Esomeprazole Plus Aspirin for the Treatment of Aspirin-Related Peptic Ulcers

Am J Gastroenterol 2012.