Systematic review: Helicobacter pylori and upper gastrointestinal bleeding risk in patients taking aspirin
Résumé
Background Aspirin is widely used to modify the risk of recurrent vascular events. It is, however, associated with increased upper gastrointestinal bleeding (UGIB) risk. The influence of Helicobacter pylori on this risk is uncertain. Aim To determine the influence of H. pylori on UGIB risk in patients taking aspirin. Methods MEDLINE and EMBASE databases were searched. All studies providing data regarding H. pylori infection in adults taking aspirin and presenting with UGIB were included. Results 13 studies: 1 case-control, 10 cohort studies and 2 randomised-controlled trials (RCTs). The case-control study (n=245) determined H. pylori to be a significant independent risk factor for UGIB. The cohort studies were heterogeneous, varying in inclusion criteria, doses and duration of aspirin used, mode of H. pylori testing and causative GI pathology considered. Comprising 5465 patients, H. pylori infection was tested for in 163 (0.03%) aspirin users with UGIB. The RCTs yielded no significant results. Conclusions The current data is not sufficient to allow meta-analyses. The widely held belief that H. pylori is a risk factor for UGIB in regular aspirin users is not supported by the very limited evidence available.
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