Long-term use of low-dose aspirin and the risk of Helicobacter pylori infection and the effect of Helicobacter pylori eradication treatment: A Prospective Case-Control Analysis
Authors: Liu Shixiong , Shengyi Yang , Yuqin Qiao , Shixiong Liu 
Published: May 2024

Objective To investigate the relationship between long-term use of low-dose aspirin and Helicobacter pylori (HP) infection and its effect on eradication and recurrence of HP.
Methods From March 2019 to December 2020, 3256 patients with cardiovascular and cerebrovascular diseases who were treated in the Affiliated Hospital of Gansu University of Chinese Medicine, Zhangye Second People's Hospital of Gansu Province, Tianshui Hospital of Integrated Traditional Chinese and Western Medicine of Gansu Province, and the First Hospital of Lanzhou University were selected as the study objects. The patients ranged in age from 34 to 93(51.9±9.1) years, including 2147 (65.9%) males and 1109 (34.1%) females. According to the results of C14-urea breath test (C14-UBT), 1733 cases of HP infection and 1523 cases of HP non-infection were divided into two groups. Logistic regression analysis，both univariate and multivariate, was used to investigate the relationship between aspirin use and HP infection. Parallel to this, a prospective case-control analysis was performed, and 859 patients with hypertension combined with HP were selected as the study objects. The patients ranged in age from 43 to 71(50.3±8.4) years, with 568 males (66.1%) and 291 females (33.9%). According to the medication situation, the subjects were divided into aspirin group (432 cases, in addition to taking antihypertensive drugs combined with low-dose aspirin treatment), non-aspirin group (427 cases, only taking conventional antihypertensive drugs), in addition, patients with current HP infection but no hypertension and other acute and chronic diseases were selected as the control group (418 cases). To compare the efficacy, safety and recurrence of HP after 1 year and 3 years of bismuth-containing quadruple therapy.
Results The overall infection rate of HP was 53.3% (1733/3256). The results of univariate analysis showed that the infection rate of female was higher than that of male [56.4% (625/1109) vs. 51.6% (1108/2147). χ²=6.628, P=0.010], the age of the HP infected group was higher than that of the uninfected group (52.1±9.2 vs. 50.4±8.9, t=3.166, P=0.002), and the body mass index of the HP infected group was higher than that of the uninfected group (24.59±3.11 vs. 24.36±3.01). t=2.135, P=0.033), LDL cholesterol (2.36±0.61 vs. 2.29±0.57, t=3.174, P=0.002) and fasting blood glucose (5.35±0.53 vs. 5.22±0.52, t=2.519, P=0.024) were higher than those in uninfected group. The infection rate of patients who took low-dose aspirin for a long time was higher than that of those who did not take aspirin [56.6% (674/1191) vs. 51.3% (1059/2065), χ²=8.548, P=0.003]. Multivariate Logistic regression analysis showed that the older the age, the higher the risk of H.pylori infection (OR=1.041, 95%CI: 1.008-1.086, P=0.003), and the risk of infection in females was higher than that in males (OR=1.332, 95%CI: 1.098-1.627, P=0.004), higher fasting blood glucose increased the risk of infection (OR=1.528, 95%CI: 1.337-2.189, P<0.001), higher LDL cholesterol increased the risk of infection (OR=1.103, 95%CI: 1.034-1.392, P=0.007), long-term aspirin increased the risk of infection (OR=1.526, 95%CI: 1.231-2.015, P<0.001), after controlling for age, sex, and body mass index, long-term aspirin use still increased the risk of infection (OR=1.433, 95%CI: 1.196-1.947, P<0.001). The overall eradication rates were 87.6% (1077/1229), 87.8% (367/418), 88.5% (361/408) and 86.6% (349/403) in the treatment group, observation group and control group, respectively. According to intention analysis, the overall eradication rate was 84.3% (1077/1277), 84.9% (367/432), 84.5% (361/427) and 83.5% (349/418), respectively, and the comparison was not statistically significant (P< 0.05). The overall 1-year recurrence rate was 1.3% (14/1046), and the recurrence rates of the three groups were 1.10% (4/359), 1.70% (6/352) and 1.20% (4/335), respectively, with no statistical significance (P<0.05). The overall recurrence rate at 3 years was 3.1% (32/1046), and the recurrence rate in the three groups was 5.30% (19/359), 1.90% (7/352) and 1.70% (6/335), respectively. The recurrence rate in the treatment group was higher than that in the observation group and control group (χ² =6.118 and 5.507, P= 0.01 and 0.015, respectively). The main adverse reactions in the first month of eradication treatment were constipation and mild nausea, and there was no statistical significance between the three groups (P>0.05).
Conclusion Long-term use of low-dose aspirin increases the risk of HP infection and the recurrence rate in 3 years after eradication. It is suggested that HP should be tested and eradicated regularly in long-term users.