Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin

Aim: To evaluate the role of Helicobacter pylori infection and other clinical factors in the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Subjects and methods: A case-control study was carried out of consecutive current users of low-dose aspirin admitted because of upper gastrointestinal bleeding. Within a cohort of 695 patients with upper gastrointestinal bleeding. 98 patients had taken low-dose aspirin and no other non-steroidal anti-inflammatory drug. Controls were 147 low-dose aspirin users without upper gastrointestinal bleeding of similar age, sex and extent of aspirin use as cases. H. pylori infection was determined by CagA/VacA serology and C-13-urea breath test in all cases and controls. Adjusted odds ratios (OR) are provided. Results: H. pylori infection was identified as an independent risk factor of upper gastrointestinal bleeding in this Population (OR, 4.7; 95%, confidence interval (95% CI), 2.0-10.9). but the presence of CagA-positive serology was not. Other risk factors identified were a previous ulcer history (OR, 15.2; 95% CI, 3.8-60.1), alcohol use (OR, 4.2: 95% CI, 1.7-10.4) and use of calcium channel blockers (OR. 2.54: 95% CI. 1.25-5.14). Antisecretory therapy (OR, 0.1: 95% CI, 0.02-0.3) and nitrovasodilators (OR. 0.2: 95% CI, 0.1-0.6) decreased the risk of bleeding. Conclusions: H. pylori infection is a risk factor for upper gastrointestinal bleeding in low-dose aspirin users, which might have therapeutic implications in high-risk patients.