Korean J Gastroenterol.  2020 Nov;76(5):238-241. 10.4166/kjg.2020.140.

Prevention of Peptic Ulcer Associated with Aspirin and Antiplatelet Agent

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

The Korean guidelines for the Clinical Guidelines for Drug-related Peptic Ulcer were revised under the Korean College of Helicobacter and Upper Gastrointestinal Research in 2020. In these revised guidelines, treatment for Helicobacter pylori infections is recommended in patients with a history of peptic ulcers and are receiving long-term low-dose aspirin therapy to prevent peptic ulcers and complications. The maintenance of anti-ulcer drugs, such as proton pump inhibitors, is also recommended after H. pylori eradication if patients require other antiplatelet agents or anticoagulants. Regardless of H. pylori eradication, when patients with a history of peptic ulcer take long-term low dose aspirin, the concomitant use of a proton pump inhibitor according to the severity of the peptic ulcer is recommended.

Keyword

Peptic ulcer; Aspirin; Antiplatelet agent; Guideline

Reference

1. Ng FH, Wong SY, Chang CM, et al. 2003; High incidence of clopidogrel-associated gastrointestinal bleeding in patients with previous peptic ulcer disease. Aliment Pharmacol Ther. 18:443–449. DOI: 10.1046/j.1365-2036.2003.01693.x. PMID: 12940930.
Article
2. Patrono C, Bachmann F, Baigent C, et al. 2004; Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European Society of Cardiology. Eur Heart J. 25:166–181. DOI: 10.1016/j.ehj.2003.10.013. PMID: 14720534.
Article
3. Jhun HJ, Sung NJ, Kim SY. 2013; Knee pain and its severity in elderly Koreans: prevalence, risk factors and impact on quality of life. J Korean Med Sci. 28:1807–1813. DOI: 10.3346/jkms.2013.28.12.1807. PMID: 24339713. PMCID: PMC3857379.
Article
4. Lee JH, Lim NK, Cho MC, Park HY. 2016; Epidemiology of heart failure in Korea: present and future. Korean Circ J. 46:658–664. DOI: 10.4070/kcj.2016.46.5.658. PMID: 27721857. PMCID: PMC5054178.
Article
5. Cutlip DE, Baim DS, Ho KK, et al. 2001; Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation. 103:1967–1971. DOI: 10.1161/01.CIR.103.15.1967. PMID: 11306525.
6. Wang F, Stouffer GA, Waxman S, Uretsky BF. 2002; Late coronary stent thrombosis: early vs. late stent thrombosis in the stent era. Catheter Cardiovasc Interv. 55:142–147. DOI: 10.1002/ccd.10041. PMID: 11835636.
Article
7. Peters RJ, Mehta SR, Fox KA, et al. 2003; Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the clopidogrel in unstable angina to prevent recurrent events (CURE) study. Circulation. 108:1682–1687. DOI: 10.1161/01.CIR.0000091201.39590.CB. PMID: 14504182.
Article
8. Berger PB, Bhatt DL, Fuster V, et al. 2010; Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease: results from the clopidogrel for high atherothrombotic risk and ischemic stabilization, management, and avoidance (CHARISMA) trial. Circulation. 121:2575–2583. DOI: 10.1161/CIRCULATIONAHA.109.895342. PMID: 20516378.
Article
9. Bhatt DL, Fox KA, Hacke W, et al. 2006; Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 354:1706–1717. DOI: 10.1056/NEJMoa060989. PMID: 16531616.
10. Moukarbel GV, Signorovitch JE, Pfeffer MA, et al. 2009; Gastrointestinal bleeding in high risk survivors of myocardial infarction: the VALIANT trial. Eur Heart J. 30:2226–2232. DOI: 10.1093/eurheartj/ehp256. PMID: 19556260.
Article
11. Kim JI, Kim SG, Kim N, et al. 2009; Changing prevalence of upper gastrointestinal disease in 28 893 Koreans from 1995 to 2005. Eur J Gastroenterol Hepatol. 21:787–793. DOI: 10.1097/MEG.0b013e32830e285a. PMID: 19404205.
12. Shiotani A, Kamada T, Haruma K. 2008; Low-dose aspirin-induced gastrointestinal diseases: past, present, and future. J Gastroenterol. 43:581–588. DOI: 10.1007/s00535-008-2206-5. PMID: 18709479.
Article
13. Lee JH, Lee YC, Jeon SW, et al. 2009; Guidelines of prevention and treatment for NSAID-related peptic ulcers. Korean J Gastroenterol. 54:309–317. DOI: 10.4166/kjg.2009.54.5.309. PMID: 19934612.
Article
14. Joo MK, Park CH, Kim JS, et al. 2020; Clinical guidelines for drug-induced peptic ulcer, 2020 revised edition. Korean J Gastroenterol. 76:108–133. DOI: 10.4166/kjg.2020.76.3.108. PMID: 32969360.
Article
15. Chan FK, Ching JY, Suen BY, Tse YK, Wu JC, Sung JJ. 2013; Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology. 144:528–535. DOI: 10.1053/j.gastro.2012.12.038. PMID: 23333655.
Article
16. Chan FK, Chung SC, Suen BY, et al. 2001; Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med. 344:967–973. DOI: 10.1056/NEJM200103293441304. PMID: 11274623.
17. Lai KC, Lam SK, Chu KM, et al. 2002; Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med. 346:2033–2038. DOI: 10.1056/NEJMoa012877. PMID: 12087138.
Article
18. Konturek JW, Dembinski A, Konturek SJ, Stachura J, Domschke W. 1998; Infection of Helicobacter pylori in gastric adaptation to continued administration of aspirin in humans. Gastroenterology. 114:245–255. DOI: 10.1016/S0016-5085(98)70474-3. PMID: 9453483.
Article
19. Hunt RH, Bazzoli F. 2004; Review article: should NSAID/low-dose aspirin takers be tested routinely for H. pylori infection and treated if positive? Implications for primary risk of ulcer and ulcer relapse after initial healing. Aliment Pharmacol Ther. 19 Suppl 1:9–16. DOI: 10.1111/j.0953-0673.2004.01830.x. PMID: 14725573.
20. Malfertheiner P, Megraud F, O'Morain CA, et al. 2012; Management of Helicobacter pylori infection--the Maastricht IV/Florence consensus report. Gut. 61:646–664. DOI: 10.1136/gutjnl-2012-302084. PMID: 22491499.
21. Iwakiri R, Higuchi K, Kato M, et al. 2014; Randomised clinical trial: prevention of recurrence of peptic ulcers by rabeprazole in patients taking low-dose aspirin. Aliment Pharmacol Ther. 40:780–795. DOI: 10.1111/apt.12907. PMID: 25100080.
Article
22. Sanuki T, Fujita T, Kutsumi H, et al. 2012; Rabeprazole reduces the recurrence risk of peptic ulcers associated with low-dose aspirin in patients with cardiovascular or cerebrovascular disease: a prospective randomized active-controlled trial. J Gastroenterol. 47:1186–1197. DOI: 10.1007/s00535-012-0588-x. PMID: 22526273.
Article
23. Scheiman JM, Devereaux PJ, Herlitz J, et al. 2011; Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON). Heart. 97:797–802. DOI: 10.1136/hrt.2010.217547. PMID: 21415072. PMCID: PMC3088470.
Article
24. Sugano K, Choi MG, Lin JT, et al. 2014; Multinational, double-blind, randomised, placebo-controlled, prospective study of esomeprazole in the prevention of recurrent peptic ulcer in low-dose acetylsalicylic acid users: the LAVENDER study. Gut. 63:1061–1068. DOI: 10.1136/gutjnl-2013-304722. PMID: 24326741.
Article
25. Sung JJ, Lau JY, Ching JY, et al. 2010; Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med. 152:1–9. DOI: 10.7326/0003-4819-152-1-201001050-00179. PMID: 19949136.
26. Whellan DJ, Goldstein JL, Cryer BL, et al. 2014; PA32540 (a coordinated-delivery tablet of enteric-coated aspirin 325 mg and immediate-release omeprazole 40 mg) versus enteric-coated aspirin 325 mg alone in subjects at risk for aspirin-associated gastric ulcers: results of two 6-month, phase 3 studies. Am Heart J. 168:495–502.e4. DOI: 10.1016/j.ahj.2014.05.017. PMID: 25262259.
Article
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