Low-dose aspirin (ASA) has emerged as the most important cause of peptic ulcer bleeding
worldwide. In western countries, ASA has overtaken non steroidal antiinflammatory drugs
(NSAIDs) as a major cause of peptic ulcer bleeding in the elderly population [1,2].
Management of peptic ulcer bleeding in patients receiving ASA for cardiothrombotic diseases
is a clinical dilemma. In a randomized trial of continuous versus interrupted ASA therapy
after endoscopic treatment of peptic ulcer bleeding, patients who discontinued ASA had a
10-fold increased incidence of all-cause mortality compared to those who received continuous
ASA therapy. On the other hand, patients receiving continuous ASA therapy had a two-fold
increased risk of early rebleeding . Thus, preventing the occurrence of peptic ulcer
bleeding in ASA users is important in reducing morbidity and mortality.
Given the uncertain clinical utility of Helicobacter Pylori (Hp) testing in ASA users, this
prospective cohort study aims to determine whether testing for Hp will have any impact on the
long-term incidence of ulcer bleeding in ASA users with high ulcer risk. The investigators
hypothesize that among ASA users with Hp infection and ulcer bleeding, the long-term
incidence of recurrent ulcer bleeding with ASA use will be low after eradication of Hp alone.