Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Balancing good and evil of aspirin effect on heart and stomach

I get this question almost everyday. "Aspirin is good for my heart but bad for my stomach. What should I do?" The answer to this simple question is how ever not very simple since we are comparing apples and oranges. Every patient needs to be individualized and trade-off assessed. Having said that, if you are at high risk for ulcers and low risk for heart disease, the cardiac protection by aspirin may not be worth it.

A recent study by Drs Hernandez-Diaz and Garcia examined estimated risk of gastrointestinal complications due to aspirin among patients in different types of patients. The factors included advanced age, male sex, prior ulcer history and use of non-steroidal anti-inflammatory drugs (NSAIDs).

They estimated that average excess risk of upper gastrointestinal complications is 5 extra cases per 1,000 aspirin users per year. It is however increased to 10 or even more extra cases per 1,000 person-years in certain high-risk populations.

Take home message: The gastrointestinal complication risk in your case may offset the cardioprotective benefit if your risk of ulcers is high while the cardiovascular risk is low. Because of an element of subjectivity, it is possible that different physicians may come to different conclusions in any particular case.

Gastric ulcer, cancer and endoscopy

Gastric (stomach) ulcers occur frequently and may be cancerous even though they may appear benign during EGD or upper GI endoscopy (upper GI scope). There has been an ongoing debate whether to perform a repeat endoscopy in patients with these ulcers to make sure there is no cancer.

Dr. Hopper and colleagues from United Kingdom examined this issue and published their findings in the journal Gastric Cancer (2006).

These investigators studied 544 patients with apparent benign ulcers of whom 51% underwent a repeat endocopy. Twelve of these ulcers were then found to be cancerous. They compared this group to 296 other patients diagnosed with gastric cancers in this time period. They found that GU cancer group had earlier stage disease and were to survive long term than patients in the comparison cohort.

They concluded that follow up endoscopy of every 50 patients with an apparently benign gastric ulcer will identify 1 patient with cancer. Such an early detection would lead to improved outcome.

Do you have ulcers? Remember gastric ulcers are different from duodenal ulcers since duodenal ulcers rarely are malignant. Most common cause of peptic ulcer disease is the infection with Helicobacter pylori.