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      Clinical Risk Factors for Gastroduodenal Ulcer in Romanian Low-Dose Aspirin Consumers

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          Abstract

          Background. Aspirin use for cardiovascular or cancer prevention is limited due to its gastrointestinal side effects. Objective. Our prospective, observational case-control study aims to identify the predictive factors for ulcers in low-dose aspirin consumers (75–325 mg/day). Methods. The study included patients who underwent an upper digestive endoscopy and took low-dose aspirin treatment. Results. We recruited 51 patients with ulcer (ulcer group) and 108 patients with no mucosal lesions (control group). In univariate analysis, factors significantly associated with ulcers were male gender ( p = 0.001), anticoagulants ( p = 0.029), nonsteroidal anti-inflammatory drugs ( p = 0.013), heart failure ( p = 0.007), liver ( p = 0.011) or cerebrovascular disease ( p = 0.004), diabetes mellitus ( p = 0.043), ulcer history ( p = 0.044), and alcohol consumption ( p = 0.018), but not Helicobacter pylori infection ( p = 0.2). According to our multivariate regression analysis results, history of peptic ulcer (OR 3.07, 95% CI 1.06–8.86), cotreatment with NSAIDs (OR 8, 95% CI 2.09–30.58) or anticoagulants (OR 4.85, 95% CI 1.33–17.68), male gender (OR 5.2, 95% CI 1.77–15.34), and stroke (OR 7.27, 95% CI 1.40–37.74) remained predictors for ulcer on endoscopy. Conclusions. Concomitant use of NSAIDs or anticoagulants, comorbidities (cerebrovascular disease), and male gender are the most important independent risk factors for ulcer on endoscopy in low-dose aspirin consumers, in a population with a high prevalence of H. pylori infection.

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          Most cited references36

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          Prevalence of Helicobacter pylori infection worldwide: a systematic review of studies with national coverage.

          The systematic assessment of large population-based surveys addressing the prevalence of Helicobacter pylori infection may provide robust evidence for understanding the trends in the exposure to this major risk factor across settings with distinct patterns of gastric cancer variation. Our aim was to describe the prevalence of H. pylori infection in different countries and periods, through systematic review of the literature. We searched PubMed from inception up to September 2013 to identify original studies reporting on the prevalence of H. pylori, and only those evaluating samples with national coverage were included. We identified 37 eligible studies including data for 22 countries. The prevalences were higher in Central/South America and Asia, and at least two-fold higher in countries with high gastric cancer incidence. In most countries presenting data for different time periods, the prevalences were usually lower in the most recent surveys. However, there was little variation in settings where prevalences were already low. Among countries with high prevalence of H. pylori infection there is an ample scope for reducing its burden in the next decades, whereas further declines in settings with already low prevalences will require more intensive efforts.
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            ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents.

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              Cigarette smoking and gastrointestinal diseases: the causal relationship and underlying molecular mechanisms (review).

              Cigarette smoking is an important risk factor for gastrointestinal (GI) disorders, including peptic ulcers, inflammatory bowel diseases, such as Crohn's disease and cancer. In this review, the relationship between smoking and GI disorders and the underlying mechanisms are discussed. It has been demonstrated that cigarette smoking is positively associated with the pathogenesis of peptic ulcers and the delay of ulcer healing. Mechanistic studies have shown that cigarette smoke and its active ingredients can cause mucosal cell death, inhibit cell renewal, decrease blood flow in the GI mucosa and interfere with the mucosal immune system. Cigarette smoking is also an independent risk factor for various types of cancer of the GI tract. In this review, we also summarize the mechanisms through which cigarette smoking induces tumorigenesis and promotes the development of cancer in various sections of the GI tract. These mechanisms include the activation of nicotinic acetylcholine receptors, the formation of DNA adducts, the stimulation of tumor angiogenesis and the modulation of immune responses in the GI mucosa. A full understanding of these pathogenic mechanisms may help us to develop more effective therapies for GI disorders in the future.
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                Author and article information

                Journal
                Gastroenterol Res Pract
                Gastroenterol Res Pract
                GRP
                Gastroenterology Research and Practice
                Hindawi Publishing Corporation
                1687-6121
                1687-630X
                2016
                8 August 2016
                : 2016
                : 7230626
                Affiliations
                1University of Medicine and Pharmacy, Tirgu Mureș, Gheorghe Marinescu 38, 540139 Mures, Romania
                2University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj-Napoca, 8 Victor Babeş, 400012 Cluj-Napoca, Romania
                3Emergency County Hospital, Tirgu Mures, Gheorghe Marinescu 50, 540136 Mures, Romania
                Author notes

                Academic Editor: Vikram Kate

                Author information
                http://orcid.org/0000-0003-2115-6576
                http://orcid.org/0000-0002-4557-5364
                http://orcid.org/0000-0002-6467-6275
                http://orcid.org/0000-0002-3235-524X
                Article
                10.1155/2016/7230626
                4992789
                1a3c6e87-17a5-444e-aef2-1e476449945d
                Copyright © 2016 Anca Negovan et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 April 2016
                : 1 July 2016
                : 11 July 2016
                Funding
                Funded by: University of Medicine and Pharmacy of Tirgu Mures, Romania
                Award ID: Nr. 11/23.12.2014
                Categories
                Research Article

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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