Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin

Aliment Pharmacol Ther. 2005 Nov 1;22(9):795-801. doi: 10.1111/j.1365-2036.2005.02649.x.


Background: Aspirin is valuable for preventing vascular events, but information about ulcer frequency is necessary to inform risk-benefit decisions in individual patients.

Aim: To determine ulcer prevalence and incidence in a population representative of those given aspirin therapy and evaluate risk predictors.

Methods: Patients taking aspirin 75-325 mg daily were recruited from four countries. Exclusions included use of gastroprotectant drugs or other non-steroidal anti-inflammatory drugs. We measured point prevalence of endoscopic ulcers, after quantitating dyspeptic symptoms. Incidence was assessed 3 months later in those eligible to continue (no baseline ulcer or reason for gastroprotectants).

Results: In 187 patients, ulcer prevalence was 11% [95% confidence interval (CI) 6.3-15.1%]. Only 20% had dyspeptic symptoms, not significantly different from patients without ulcer. Ulcer incidence in 113 patients followed for 3 months was 7% (95% CI 2.4-11.8%). Helicobacter pylori infection increased the risk of a duodenal ulcer [odds ratio (OR) 18.5, 95% CI 2.3-149.4], as did age >70 for ulcers in stomach and duodenum combined (OR 3.3, 95% CI 1.3-8.7).

Conclusions: Gastroduodenal ulcers are found in one in 10 patients taking low-dose aspirin, and most are asymptomatic; this needs considering when discussing risks/benefits with patients. Risk factors include older age and H. pylori (for duodenal ulcer).

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aspirin / adverse effects*
  • Duodenal Ulcer / chemically induced*
  • Duodenal Ulcer / epidemiology
  • Duodenal Ulcer / physiopathology
  • Endoscopy, Gastrointestinal / methods
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / adverse effects*
  • Prevalence
  • Risk Assessment / methods
  • Risk Factors
  • Stomach Ulcer / chemically induced*
  • Stomach Ulcer / epidemiology
  • Stomach Ulcer / physiopathology


  • Platelet Aggregation Inhibitors
  • Aspirin