Antibiotics may reduce the risk of stomach bleeding caused by regular aspirin use

By taking antibiotics that reduce the presence of bacteria known as helicobacter pylori, patients using aspirin for extended periods experienced less bleeding in their stomachs

A study led by the University of Nottingham found that the risk of stomach bleeding caused by long-term aspirin use can be reduced with a short course of antibiotics — potentially improving the safety of aspirin when used to prevent heart attacks and strokes.

Aspirin in low doses is a useful preventative drug in people at high risk of strokes or heart attacks. However, on rare occasions, the drug can provoke internal bleeding; by thinning the blood, aspirin makes ulcers in the stomach bleed. These ulcers may be caused by a particular type of bacteria, helicobacter pylori.

The University of Nottingham team investigated whether a short course of antibiotics to remove the bacteria would reduce the risk of bleeding in aspirin users, rolling out their HEAT (Helicobacter pylori Eradication Aspirin) Trial across 1,208 UK general practices.

Those among the 30,166 people who took part in the study and tested positive for helicobacter pylori were randomised to receive antibiotics or placebos and followed for up to seven years.

Over the first two and a half years, those who had antibiotic treatment were less likely to be admitted to hospital because of ulcer bleeding than those who had dummy tablets (six versus 17).

Those who received placebos saw first hospitalisations for ulcer bleeding after six days; those who received antibiotics saw first hospitalisations for ulcer bleeding after 525 days.

Protection appeared to wane over a longer period, the team said. However, the overall rate of hospitalisation for ulcer bleeding was lower than expected. This in line with other evidence that ulcer disease is on the decline, the team added.

The results of the trial were presented in October at the United European Gastroenterology scientific meeting in Vienna, where it won an abstract prize for €10,000.

The findings of the HEAT (Helicobacter pylori Eradication Aspirin) trial are published in The Lancet.

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