Eradicating H. pylori protects against peptic ulcer bleeds among people taking aspirin, the HEAT study reports. The benefits may not, however, persist long-term.

Researchers analysed 30,166 patients from UK primary care who received at least four 28-day prescriptions for aspirin 325mg or less daily in the year before enrolment. The 17.8 per cent who were positive for H. pylori on a breath test received placebo or oral antibiotics for one week to eradicate the infection. Mean age at randomisation was 73.6 years and 72.8 per cent were male. Median follow-up was 5.0 years.

During the first 2.5 years, patients who received antibiotics were 65 per cent less likely to be hospitalised with or die from a definite or probable peptic ulcer bleed than those receiving placebo: 0.92 and 2.61 bleeds per 1,000 person years respectively. 

The number needed to treat to prevent one bleed was 238. Fewer bleeds from gastric and duodenal ulcers, rather than oesophageal ulcers, accounted for the benefit.

The rate of bleeds did not differ significantly after the first 2.5 years of follow-up, which the authors describe as “unexpected” and say further studies should investigate this “apparent” decline in protection. 

“Aspirin has many benefits in terms of reducing the risk of heart attacks and strokes in people at increased risk. There is also evidence that it is able to slow down certain cancers,” comments lead author Professor Chris Hawkey from the University of Nottingham’s School of Medicine. 

“We are pleased that the findings have shown that ulcer bleeding can be significantly reduced following a one-week course of antibiotics. The long-term implications of the results are encouraging in terms of safe prescribing.” (Lancet 2022; 400:1597-606)