Low-dose aspirin linked to increased risk of gastric, duodenal ulcers

Individuals who use low-dose aspirin are at risk of developing gastric and duodenal ulcers, especially those who have only recently initiated therapy, a study has found.

Researchers evaluated the associations between low-dose aspirin exposure and the incidence of gastric and duodenal ulcer among prevalent and new users. They used data from the German ESTHER study (n=7,737) and the UK Biobank (n=213,598) with more than 10 years of follow-up.

The prevalent-user analysis included 2,398 cases of gastric ulcer (incidence rate [IR], 0.97 per 1,000 person-years) and 1,323 cases of duodenal ulcer (IR, 0.54 per 1,000 person-years) overall.

Low-dose aspirin use showed no significant association with the risk of gastric ulcer incidence in both cohorts. However, there was a weak, statistically significantly association with the risk of duodenal ulcer incidence observed in the UK Biobank (hazard ratio [HR], 1.27, 95 percent confidence interval [CI], 1.07–1.51) but not in the ESTHER study (HR, 1.33, 95 percent CI, 0.54–3.29).

The new-user analysis, on the other hand, included 1,819 cases of gastric ulcer (IR, 0.85 per 1,000 person-years) and 970 cases of duodenal ulcer (IR, 0.45 per 1,000 person-years) during a median follow-up of 11.6 years in the UK Biobank; and 48 (IR, 0.86 per 1,000 person-years) and 18 (IR, 0.32 per 1,000 person-years) cases of gastric and duodenal ulcer, respectively, over a median follow-up of 8.6 years in the ESTHER cohort.

Low-dose aspirin conferred an increased risk of gastric ulcer incidence in the UK Biobank (HR, 1.82, 95 percent CI, 1.58–2.11) and ESTHER cohorts (HR, 2.83, 95 percent CI, 1.40–5.71). Similar patterns of association for duodenal ulcer incidence were detected in the UK Biobank (HR, 1.66, 95 percent CI, 1.36–2.04) and the ESTHER cohorts (HR, 3.89, 95 percent CI, 1.46–10.42).

The findings highlight the importance of weighing risks against benefits when considering low-dose aspirin treatment initiation and to monitor adverse gastrointestinal symptoms after the start of low-dose aspirin therapy.