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Article: Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen

TitlePreventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen
Authors
Issue Date2001
PublisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
Citation
New England Journal Of Medicine, 2001, v. 344 n. 13, p. 967-973 How to Cite?
AbstractBackground: Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients. Methods: We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months. Results: We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005). Conclusions: Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs, such as naproxen. Copyright © 2001 Massachusetts Medical Society.
Persistent Identifierhttp://hdl.handle.net/10722/162562
ISSN
2015 Impact Factor: 59.558
2015 SCImago Journal Rankings: 14.619
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, FKLen_US
dc.contributor.authorChung, SCSen_US
dc.contributor.authorSuen, BYen_US
dc.contributor.authorLee, YTen_US
dc.contributor.authorLeung, WKen_US
dc.contributor.authorLeung, VKSen_US
dc.contributor.authorWu, JCYen_US
dc.contributor.authorLau, JYWen_US
dc.contributor.authorHui, Yen_US
dc.contributor.authorLai, MSen_US
dc.contributor.authorChan, HLYen_US
dc.contributor.authorSung, JJYen_US
dc.date.accessioned2012-09-05T05:21:10Z-
dc.date.available2012-09-05T05:21:10Z-
dc.date.issued2001en_US
dc.identifier.citationNew England Journal Of Medicine, 2001, v. 344 n. 13, p. 967-973en_US
dc.identifier.issn0028-4793en_US
dc.identifier.urihttp://hdl.handle.net/10722/162562-
dc.description.abstractBackground: Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients. Methods: We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months. Results: We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005). Conclusions: Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs, such as naproxen. Copyright © 2001 Massachusetts Medical Society.en_US
dc.languageengen_US
dc.publisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/en_US
dc.relation.ispartofNew England Journal of Medicineen_US
dc.subject.meshAnti-Bacterial Agents - Therapeutic Useen_US
dc.subject.meshAnti-Inflammatory Agents, Non-Steroidal - Administration & Dosage - Adverse Effects - Therapeutic Useen_US
dc.subject.meshAnti-Ulcer Agents - Therapeutic Useen_US
dc.subject.meshAspirin - Administration & Dosage - Adverse Effectsen_US
dc.subject.meshDrug Therapy, Combinationen_US
dc.subject.meshGastrointestinal Hemorrhage - Chemically Induced - Complications - Prevention & Controlen_US
dc.subject.meshHelicobacter Infections - Complications - Drug Therapyen_US
dc.subject.meshHelicobacter Pylorien_US
dc.subject.meshHumansen_US
dc.subject.meshMetronidazole - Therapeutic Useen_US
dc.subject.meshNaproxen - Adverse Effects - Therapeutic Useen_US
dc.subject.meshOmeprazole - Therapeutic Useen_US
dc.subject.meshOrganometallic Compounds - Therapeutic Useen_US
dc.subject.meshRecurrence - Prevention & Controlen_US
dc.subject.meshTetracycline - Therapeutic Useen_US
dc.titlePreventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxenen_US
dc.typeArticleen_US
dc.identifier.emailLeung, WK:waikleung@hku.hken_US
dc.identifier.authorityLeung, WK=rp01479en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1056/NEJM200103293441304en_US
dc.identifier.pmid11274623-
dc.identifier.scopuseid_2-s2.0-0035967198en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0035967198&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume344en_US
dc.identifier.issue13en_US
dc.identifier.spage967en_US
dc.identifier.epage973en_US
dc.identifier.isiWOS:000167716600004-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridChan, FKL=7202586434en_US
dc.identifier.scopusauthoridChung, SCS=19642462800en_US
dc.identifier.scopusauthoridSuen, BY=6506058430en_US
dc.identifier.scopusauthoridLee, YT=8041471500en_US
dc.identifier.scopusauthoridLeung, WK=7201504523en_US
dc.identifier.scopusauthoridLeung, VKS=7102336049en_US
dc.identifier.scopusauthoridWu, JCY=7409253910en_US
dc.identifier.scopusauthoridLau, JYW=13907867100en_US
dc.identifier.scopusauthoridHui, Y=7103107510en_US
dc.identifier.scopusauthoridLai, MS=55205766800en_US
dc.identifier.scopusauthoridChan, HLY=16038785900en_US
dc.identifier.scopusauthoridSung, JJY=24473715000en_US
dc.identifier.citeulike11522558-

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