The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding.

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 13C‐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.

To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates.

The use of the antiplatelet agent triflusal and other cardiovascular drugs apart from low-dose aspirin was not associated with gastrointestinal bleeding. The use of either NSAIDs or aspirin increased the risk of gastrointestinal bleeding but, among the analgesics, only metamizol induced a small increase in the risk of gastrointestinal bleeding.

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