Does long-term aspirin use have any effect on Helicobacter pylori eradication?

Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection, and recent reports from different countries report eradication rates lower than 80% with triple therapy. The aim of this pilot study was to investigate the efficacy of standard triple eradication regimen in long-term aspirin users.

The study population consisted of 77 aspirin using patients with dyspeptic symptoms and 79 age- and sex-matched dyspeptic patients without aspirin use as a control group. Both the study group and control patients were given lansoprazole (30 mg twice a day), clarithromycin (500 mg twice a day) and amoxicillin (1 g twice a day) (LCA) for 14 days as the eradication regimen. Patients on the study group were allowed to take aspirin during the eradication regimen (LCAAsp). Eradication was defined as the absence of H pylori as assessed with the C-urea breath test and H pylori stool antigen test 8 weeks after the end of the antimicrobial therapy.

The H pylori eradication rate in the LCAAsp group was 64/77 [83%, 95% confidence interval (CI): 79%-94%] with intention-to-treat (ITT) analysis and 64/75 (85%, 95% CI: 82%-96%) with per protocol (PP) analysis, and the H pylori eradication rate in the LCA group was 42/79 (53%, 95% CI: 43%-65%) with ITT analysis and 42/75 (56%, 95% CI: 46%-68%) with PP analysis. The difference between the groups both with ITT analysis and with PP analysis was statistically significant (P < 0.05).

These data suggest that H pylori eradication rate with standard triple eradication regimen is significantly higher among long-term aspirin users than in controls.