Risk of Peptic Ulcer Bleeding Associated with Helicobacter pylori Infection, Nonsteroidal Anti-inflammatory Drugs, and Low-dose Aspirin Therapy in Peptic Ulcer Disease: A Case-control Study

Abstract

Background and Aims: The association of Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin in the risk of peptic ulcer bleeding (PUB) has not yet been established. Also, it remains unclear whether aspirin and NSAIDs increase the risk of bleeding from gastroduodenal ulcers. This study aimed to determine the risk of PUB associated with H. pylori infection, NSAIDs and low-dose aspirin in peptic ulcer disease (PUD). Methods: This case-control study included 340 hospitalized patients with PUB and age, sex-matched 340 patients with PUD diagnosed endoscopically at our institution from 2012 to 2016. Adjusted odds ratio (AOR) for the risk of PUB was calculated by logistic regression analysis. Results: The study included 340 cases of PUB and 340 controls of PUD. 57.9% of cases and 54.1% of controls had H. pylori infection (P=.31). In multivariate analysis, low-dose aspirin (AOR, 4.36; P=.0001), NSAID (AOR, 3.48; P=.0001) and smoking (AOR, 2.34; P=.0001) increased risk of PUB compared to PUD. No significant interactions were observed between H. pylori infection and NSAIDs or low-dose aspirin use in logistic regression analysis. Conclusions: Both NSAIDs and aspirin are independent risk factors for bleeding in patients with PUD, however, there were no additive effects between low-dose aspirin or NSAID use and H. pylori infection. Therefore, preventive strategies for bleeding may be needed in patients with PUD taking low-dose aspirin and NSAIDs continuously.