Helicobacter pylori infection as a risk factor for gastrointestinal symptoms in patients using aspirin to prevent ischaemic heart disease

Background: Aspirin use in the secondary prevention of ischaemic heart disease may provoke gastrointestinal discomfort. Objective: To register gastrointestinal symptoms and complications in patients with cardiovascular disease using aspirin and to relate these symptoms to infection with H. pylori. Methods: Blood samples were obtained from 398 consecutive patients in the Coronary-Care Unit, University Hospital Nijmegen and analysed for serum antibody levels to H. pylori infection. Questionnaires were sent 2 weeks after discharge to assess gastrointestinal symptoms. Results: Questionnaires were returned by 314 patients (79%). A total of 183 out of 314 patients (46%) reported gastrointestinal symptoms. Of 238 patients using 80-100 mg aspirin daily, 145 (61%) recorded gastrointestinal symptoms. Besides aspirin, the use of calcium antagonists was correlated with gastrointestinal symptoms, Of the 128 patients using calcium antagonists, 84 (66%) reported gastrointestinal symptoms. The prevalence of gastrointestinal symptoms in H. pylori-positive and -negative patients using aspirin was 48% and 52%, respectively. Conclusions: Two weeks after discharge almost 50% of the patients with cardiovascular disease experienced gastrointestinal symptoms, especially patients using aspirin or calcium antagonists. Patients seropositive for H. pylori and using aspirin or calcium antagonists did not have more gastrointestinal discomfort compared to non-infected patients.