Must We Stop Prophylactic Aspirin in Patients Who Develop Peptic Ulcers?

Allan S. Brett, MD

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Abstract and Introduction

Abstract

Proton-pump inhibitors usually heal aspirin-associated ulcers, even if aspirin is continued.

Introduction

When patients who take daily prophylactic aspirin develop gastroduodenal ulceration, clinicians must decide whether to continue aspirin while treating the ulcers. To address this dilemma, researchers in Taiwan identified 178 patients who developed dyspepsia while taking low-dose aspirin for primary or secondary cardiovascular prophylaxis and who exhibited gastric or duodenal ulceration at endoscopy. Patients were randomized to receive esomeprazole alone (40 mg daily) or esomeprazole plus aspirin (100 mg daily). Helicobacter pylori-positive patients received eradication therapy.

On repeat endoscopy at 8 weeks, ulcers had healed completely in 74% of patients in each group. Dyspeptic symptoms improved similarly in both groups, and no patients developed bleeding ulcer, myocardial infarction, or stroke.

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