Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Office for Research, Austin Health, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2019 Mar;34(3):517-525. doi: 10.1111/jgh.14539. Epub 2018 Dec 17.
Owing to wide-spread use, low-dose aspirin (LDA) produces a substantial amount of peptic ulcer disease. Current guidelines are ambivalent about the need for Helicobacter pylori eradication to protect against LDA ulcers. This study aimed to determine, through meta-analysis, if (and by how much) infection alters the baseline risk of peptic ulcers during LDA therapy.
Literature screening was performed in MEDLINE and EMBASE from inception to May 2018. Original studies reporting prevalence or incidence of uncomplicated ulcers in LDA users were included. Ulcer endpoints needed to be specified separately, according to H. pylori infection status. Meta-analysis was performed in MIX 2.0 Pro.
Ten cross-sectional studies and seven randomized controlled trials were included (n = 5964). The pooled odds ratios with 95% confidence intervals (CI) for the risk of LDA ulcers in H. pylori-positive versus H. pylori-negative individuals were 1.68 (95%CI 1.40-2.02) and 1.65 (95%CI 1.29-2.08) under fixed-effects and random-effects models, respectively. Heterogeneity among studies was minimal (I = 26.9%). After adjusting for the protective effects of antisecretory drugs, the odds ratios increased to 1.94 (95%CI 1.54-2.46).
This analysis suggests that H. pylori increases the risk of LDA ulcers by almost 70% in a population where some were taking proton pump inhibitors and/or other acid suppressants. Without antisecretory drugs, the risk almost doubles. Clinically, these findings may support the use of a test-and-treat approach to H. pylori in LDA users, particularly those already at higher risk of developing peptic ulcers.
由于广泛使用，低剂量阿司匹林（LDA）会导致大量消化性溃疡病。目前的指南对是否需要根除幽门螺杆菌（H. pylori）以预防 LDA 溃疡存在矛盾。本研究旨在通过荟萃分析确定（以及多大程度上确定）感染是否会改变 LDA 治疗期间消化性溃疡的基线风险。
从 MEDLINE 和 EMBASE 数据库的创建到 2018 年 5 月进行文献筛选。纳入报告 LDA 使用者中未合并溃疡的患病率或发病率的原始研究。根据 H. pylori 感染状态，需要分别指定溃疡终点。在 MIX 2.0 Pro 中进行荟萃分析。
纳入了 10 项横断面研究和 7 项随机对照试验（n=5964）。在固定效应和随机效应模型下，H. pylori 阳性与 H. pylori 阴性个体中 LDA 溃疡风险的合并比值比（OR）及其 95%置信区间（CI）分别为 1.68（95%CI 1.40-2.02）和 1.65（95%CI 1.29-2.08）。研究之间的异质性很小（I²=26.9%）。在调整了抗分泌药物的保护作用后，OR 增加到 1.94（95%CI 1.54-2.46）。
本分析表明，在接受质子泵抑制剂和/或其他酸抑制剂治疗的人群中，H. pylori 将 LDA 溃疡的风险增加了近 70%。如果没有抗分泌药物，风险几乎会增加一倍。临床上，这些发现可能支持在 LDA 使用者中采用检测和治疗 H. pylori 的方法，尤其是那些已经有较高消化性溃疡风险的患者。
