FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 346:2033-2038 June 27, 2002 Number 26 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The role of gastric acid suppression in preventing the recurrence of ulcer complications after the eradication of Helicobacter pylori infection in patients taking long-term low-dose aspirin is uncertain.

Methods We enrolled 123 patients who had ulcer complications after using low-dose aspirin continuously for more than one month and who had H. pylori infection. After the ulcers had healed and the H. pylori infection was eradicated, the patients were randomly assigned to treatment with 30 mg of lansoprazole daily or placebo, in addition to 100 mg of aspirin daily, for 12 months. The primary end point was the recurrence of ulcer complications.

Results During a median follow-up of 12 months, 9 of the 61 patients in the placebo group (14.8 percent), as compared with 1 of the 62 patients in the lansoprazole group (1.6 percent), had a recurrence of ulcer complications (adjusted hazard ratio, 9.6; 95 percent confidence interval, 1.2 to 76.1). Of these 10 patients, 4 had evidence of a recurrence of H. pylori infection and 2 had taken nonsteroidal antiinflammatory drugs before the onset of complications. Patients in the lansoprazole group were significantly less likely to have a recurrence of ulcer complications than patients in the placebo group (P=0.008). There was no significant difference in mortality between the two groups.

Conclusions In patients who had ulcer complications related to the long-term use of low-dose aspirin, treatment with lansoprazole in addition to the eradication of H. pylori infection significantly reduced the rate of recurrence of ulcer complications.

Source Information

From the Departments of Medicine (K.C.L., S.K.L., B.C.Y.W., W.M.H., W.H.C.H., G.K.K.L., W.M.W., M.F.Y., A.O.O.C., C.L.L.) and Surgery (K.M.C., J.W.), University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

Address reprint requests to Dr. K.C. Lai at the Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China, or at kclai{at}hku.hk.

Full Text of this Article

Related Letters:

Lansoprazole for the Prevention of Recurrences of Ulcer Complications from Long-Term Low-Dose Aspirin
Maiden L. P., Harris A. W., Lai K. C., Hui W. M., Lam S. K.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1623-1624, Nov 14, 2002. Correspondence

This article has been cited by other articles:

• Bhatt, D. L., Scheiman, J., Abraham, N. S., Antman, E. M., Chan, F. K.L., Furberg, C. D., Johnson, D. A., Mahaffey, K. W., Quigley, E. M., Harrington, R. A., Bates, E. R., Bridges, C. R., Eisenberg, M. J., Ferrari, V. A., Hlatky, M. A., Kaul, S., Lindner, J. R., Moliterno, D. J., Mukherjee, D., Schofield, R. S., Rosenson, R. S., Stein, J. H., Weitz, H. H., Wesley, D. J. (2008). ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 52: 1502-1517 [Full Text]  
• Bhatt, D. L., Scheiman, J., Abraham, N. S., Antman, E. M., Chan, F. K.L., Furberg, C. D., Johnson, D. A., Mahaffey, K. W., Quigley, E. M. (2008). ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 118: 1894-1909 [Full Text]  
• Saini, S. D., Schoenfeld, P., Fendrick, A. M., Scheiman, J. (2008). Cost-effectiveness of Proton Pump Inhibitor Cotherapy in Patients Taking Long-term, Low-Dose Aspirin for Secondary Cardiovascular Prevention. Arch Intern Med 168: 1684-1690 [Abstract] [Full Text]  
• Pignone, M. (2008). Cost-effectiveness of Proton Pump Inhibitor Cotherapy in Patients Taking Long-term, Low-Dose Aspirin for Secondary Cardiovascular Prevention--Invited Commentary. Arch Intern Med 168: 1691-1691 [Full Text]  
• Hylek, E. M., Solarz, D. E. (2008). Dual Antiplatelet and Oral Anticoagulant Therapy: Increasing Use and Precautions for a Hazardous Combination. J Am Coll Cardiol Intv 1: 62-64 [Full Text]  
• Anderson, J. L., Adams, C. D., Antman, E. M., Bridges, C. R., Califf, R. M., Casey, D. E. Jr, Chavey, W. E. II, Fesmire, F. M., Hochman, J. S., Levin, T. N., Lincoff, A. M., Peterson, E. D., Theroux, P., Wenger, N. K., Wright, R. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Krumholz, H. M., Kushner, F. G., Lytle, B. W., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B. (2007). ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 50: e1-e157 [Full Text]  
• Malfertheiner, P, Megraud, F, O'Morain, C, Bazzoli, F, El-Omar, E, Graham, D, Hunt, R, Rokkas, T, Vakil, N, Kuipers, E J, The European Helicobacter Study Group (EHSG), (2007). Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 56: 772-781 [Abstract] [Full Text]  
• Antman, E. M., Bennett, J. S., Daugherty, A., Furberg, C., Roberts, H., Taubert, K. A. (2007). Use of Nonsteroidal Antiinflammatory Drugs: An Update for Clinicians: A Scientific Statement From the American Heart Association. Circulation 115: 1634-1642 [Full Text]  
• Knight, C. L., Fihn, S. D. (2006). Update in General Internal Medicine. ANN INTERN MED 145: 52-61 [Full Text]  
• (2005). Additional Information. JAMA 294: E1-E3 [Full Text]  
• Peterson, W. L (2005). Aspirin plus esomeprazole reduced recurrent ulcer bleeding more than clopidogrel in high risk patients. Evid. Based Med. 10: 112-112 [Full Text]  
• Saseen, J. J. (2005). ASHP Therapeutic Position Statement on the Daily Use of Aspirin for Preventing Cardiovascular Events. Am J Health Syst Pharm 62: 1398-1405 [Full Text]  
• (2005). H. pylori eradication in NSAID-associated ulcers. DTB 43: 37-40 [Abstract] [Full Text]  
• Wolk, M. J., Jacobs, A. K., Wargo, K. A., Baty, S. R., Knowles, G., Barski, P. R. Jr., Chan, F. K.L., the Gastrointestinal Research Group, (2005). Clopidogrel versus Aspirin and Esomeprazole to Prevent Recurrent Bleeding. NEJM 352: 1716-1718 [Full Text]  
• Bennett, J. S., Daugherty, A., Herrington, D., Greenland, P., Roberts, H., Taubert, K. A. (2005). The Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): A Science Advisory From the American Heart Association. Circulation 111: 1713-1716 [Full Text]  
• Chan, F. K., Ching, J. Y.L., Hung, L. C.T., Wong, V. W.S., Leung, V. K.S., Kung, N. N.S., Hui, A. J., Wu, J. C.Y., Leung, W. K., Lee, V. W.Y., Lee, K. K.C., Lee, Y. T., Lau, J. Y.W., To, K. F., Chan, H. L.Y., Chung, S.C. S., Sung, J. J.Y. (2005). Clopidogrel versus Aspirin and Esomeprazole to Prevent Recurrent Ulcer Bleeding. NEJM 352: 238-244 [Abstract] [Full Text]  
• Cryer, B. (2005). Reducing the Risks of Gastrointestinal Bleeding with Antiplatelet Therapies. NEJM 352: 287-289 [Full Text]  
• Jacobsen, R. B, Phillips, B. B. (2004). Reducing Clinically Significant Gastrointestinal Toxicity Associated with Nonsteroidal Antiinflammatory Drugs. The Annals of Pharmacotherapy 38: 1469-1481 [Abstract] [Full Text]  
• Howden, C. W (2003). Lansoprazole reduced recurrence of ulcer complications in long term use of low dose aspirin. Evid. Based Med. 8: 19-19 [Full Text]  
• Maiden, L. P., Harris, A. W., Lai, K. C., Hui, W. M., Lam, S. K. (2002). Lansoprazole for the Prevention of Recurrences of Ulcer Complications from Long-Term Low-Dose Aspirin. NEJM 347: 1623-1624 [Full Text]  
• (2002). PPIs Reduce Risk for Recurrent Ulcer Complications from Low-Dose Aspirin. JWatch Gastroenterology 2002: 1-1 [Full Text]