Prevention of gastroduodenal complications in patients taking low-dose aspirin

Use of low-dose aspirin is associated with an increased risk of gastroduodenal ulcers and upper gastrointestinal bleeding. The risk is increased by the old age and by cardiovascular and cerebrovascular diseases of the patients receiving low-dose aspirin. Combination with nonsteroidal anti-inflammatory drugs, corticosteroids or anticoagulant increases the risk of complications and should be avoided. Proton-pump inhibitor and eradication of Helicobacter pylori are not efficient in primary prevention of ulcer complications related to low-dose aspirin use. Patients at high risk of gastroduodenal complications due to age, morbidity or concomitant use of gastrotoxic therapy should be given prophylactic treatment. Assessment of what constitutes the most effective therapy (misoprostol, proton-pump inhibitor) should be defined in controlled trials. Among patients with Helicobacter pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of Helicobacter pylori is equivalent to treatment with proton-pump inhibitor in preventing recurrent bleeding. Long term treatment with proton-pump inhibitor in addition to the eradication of Helicobacter pylori should be considered in patients who had ulcer complications related to the use of low-dose aspirin.