Preventing Recurrent Upper Gastrointestinal Bleeding in Patients withHelicobacter pyloriInfection Who Are Taking Low-Dose Aspirin or Naproxen

作者：Francis K.L. Chan, S.C. Sydney Chung, Bing Yee Suen, Yuk Tong Lee, Wai K. Leung, Vincent K S Leung, Justin CY Wu, James Yun Wong Lau, Yui Hui, Moon Sing Lai, Henry Lik‐Yuen Chan, Joseph J.�Y. Sung · 发表于：New England Journal of Medicine · 年份：2001 · DOI：10.1056/nejm200103293441304 · 被引用次数：629 · 研究领域：Inflammatory mediators and NSAID effects、Helicobacter pylori-related gastroenterology studies、Antiplatelet Therapy and Cardiovascular Diseases

BACKGROUND: 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...