Low-dose aspirin-associated upper gastric and duodenal ulcers in Japanese patients with no previous history of peptic ulcers

Abstract

BackgroundLong-term administration of low-dose aspirin (LDA) is associated with a greater risk of adverse events, including gastroduodenal ulcers. The purpose of this study was to identify the risk factors for and assess the role of medication use in the development of peptic ulcer disease in Japanese patients with no history of peptic ulcers.MethodsConsecutive outpatients receiving LDA (75 mg/day) who underwent esophagogastroduodenoscopy between January and December 2010 were enrolled. Clinical parameters, peptic ulcer history, concomitant drugs, the presence of Helicobacter pylori infection, reason for endoscopy, and endoscopic findings were analysed.ResultsOf 226 total patients, 14 (6.2%) were endoscopically diagnosed with peptic ulcer. Age, sex, current smoking status, current alcohol consumption, endoscopic gastric mucosal atrophy, and abdominal symptoms were not significantly associated with peptic ulcers. Diabetes mellitus was more frequent (42.9% vs. 16.5%; P = 0.024) in patients with peptic ulcers than in those without peptic ulcers. Using multiple logistic regression analysis, co-treatment with anticoagulants or proton pump inhibitors (PPIs) was significantly associated with increased and decreased risk for peptic ulcer, respectively (odds ratio [OR], 5.88; 95% confidence interval [CI], 1.19 − 28.99; P = 0.03 and OR, 0.13; 95% CI, 0.02 − 0.73; P = 0.02, respectively). Co-treatment with additional antiplatelet agents, H2-receptor antagonists, angiotensin II Type 1 receptor blockers, angiotensin-converting enzyme inhibitor, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitor, or nonsteroidal anti-inflammatory drugs was not associated with peptic ulcer development.ConclusionThe use of PPIs reduces the risk of developing gastric or duodenal ulcers in Japanese patients taking LDA without pre-existing gastroduodenal ulcers. However, this risk is significantly increased in both patients ingesting anticoagulants and patients with diabetes. These results may help identify patients who require intensive prophylaxis against aspirin-induced peptic ulcers.

In Vitro Protective Effect of Betaine on Peroxidative Injury Caused By Ethanol and Aspirin Exposure on Rat Brain Synaptosomes

“…Overall, 100 µg/mL aspirin corresponds to a value of between 0.5 and 1 mM aspirin, which is within the therapeutic dose range of the drug (0.1-2 mM) (26). In addition, according to pharmacology experiments, 100 μg/mL aspirin is considered as a low level, and approximately 90%, which is good a percentage, of plasma salicylate is bound to albumin (27). Overall, 1 mM betaine is used for the methyl donor substrate supplementation (28).…”

Helicobacter pylori, úlcera péptica y cáncer gástrico

“…La producción de moco y bicarbonato, los fosfolípidos de membrana, el rápido recambio celular, la angiogénesis y la delicada red microvascular representan las principales barreras de defensa frente a los factores agresores; entre estos últimos sobresalen la infección por Helicobacter pylori y el consumo crónico de antiinflamatorios no esteroideos (AINE) (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Diabetes increases morbidity and mortality rates in peptic ulcer bleeding: An updated systematic review and meta-analysis

“…We selected 19 highquality studies, which consisted of 46,674 patients with diabetes and 159,630 patients without diabetes. Kawamura et al reported that DM was more frequent in patients with peptic ulcers than in those without peptic ulcers (32). Seven investigations, which included 44,647 DM patients and 141,119 non-diabetic patients, concentrated on the relationship between the morbidity rate in PUB and DM.…”