Journal of Dr. NTR University of Health Sciences (Jan 2015)
In vitro effect of aspirin on Helicobacter pylori on upper gastrointestinal tract
Abstract
The role of Helicobacter pylori in aspirin-associated gastroduodenal ulcer disease is a subject of controversy. Aspirin use is widespread, especially in elderly patients, leading to the increased incidence of gastrointestinal (GI) bleeding. Endoscopy-guided biopsy is diagnostic. H. pylori fecal antigen detection in stool samples by enzyme-linked immunosorbent assay (ELISA) is also an option. Aim: The aims of this study were to assess the in vitro action of aspirin on H. pylori and to determine whether this effect has a role in different gastroduodenal lesions. Materials and Methods: The study group consisted of 100 symptomatic cases with different upper GI tract disorders, the patients aged 20-60 years and of either sex. Ten (10) asymptomatic, apparently healthy individuals were also included as the control group, after their consent was obtained for endoscopy. Biopsy material obtained by endoscopy was subjected to rapid urease test and culture, and aspirin sensitivity was determined by incorporating 400 ug/mL of aspirin in the medium. Results and Discussion: Out of the 41 culture-positive cases, 27 isolates were aspirin-sensitive. Among the various GI disorders analyzed, aspirin-sensitive H. pylori was found mostly in cases of gastritis (7) and duodenal ulcer (7). Two of five strains from duodenitis cases, one of four from esophagitis, all four from carcinoma, five isolated from symptomatic patients without visible lesions, and only one isolated from those asymptomatic with lesion were sensitive. The aspirin-sensitive organisms may or may not be associated with lesions, but the resistant strains were definitely associated with lesions. Although these findings do not change the current clinical approach, they do emphasize the need for screening. The Helicobacter pylori stool antigen (HpSA) test is sensitive and specific for planning eradication programs of H. pylori in colonized but presymptomatic cases.
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