Incidence and Mortality of Peptic Ulcer Disease is Decreasing

Background & Aims: Involvement of Helicobacter pylori in aspirin-induced gastropathy and adaptation to aspirin remains unclear. The aim of this study was to compare gastric damage and adaptation after repeated exposures to acetylsalicylic acid in the same subjects before and after eradication of H. pylori. Methods: Before and after H. pylori eradication, 8 volunteers were given aspirin, 2 g/day during 14 days. Mucosal damage was evaluated by endoscopy and histological analysis of biopsy samples. Gastric microbleeding, DNA synthesis, prostaglandin E2 generation, and luminal contents of transforming growth factor α and its immunohistochemical expression were determined on days 0, 3, 7, and 14 of aspirin course. Results: In all subjects, aspirin-induced gastric damage that reached maximum on day 3. In H. pylori–positive subjects, this damage was maintained at a similar level up to day 14. After H. pylori eradication, the damage was significantly lessened both in endoscopy and histology at day 14 and accompanied by increased mucosal expression and luminal release of transforming growth factor α. Prostaglandin E2 generation was significantly greater in H. pylori–positive subjects than after H. pylori eradication, but aspirin treatment resulted in >90% reduction of this generation independent of H. pylori status. Conclusions: Gastric adaptation to aspirin is impaired in H. pylori–positive subjects, but eradication of this bacterium restores this process.GASTROENTEROLOGY 1998;114:245-255