Aspirin 'not to blame' for stomach bleeding - that's due to a bug, say scientists
This is a rather exciting challenge to some long-accepted wisdom
Thousands of patients are unable to take daily aspirin to prevent heart attack and stroke, because of the risk of stomach bleeding. Instead, they have to be given more expensive and sometimes less effective treatments.
But, now, scientists have identified what they think is the real cause of stomach bleeding linked to aspirin — a common stomach bug. This new theory could transform the way many people with cardiovascular disease are treated.
It also opens up the possibility that otherwise healthy people, who are currently advised not to take a daily aspirin, because of the risk of bleeding, might be able to take it safely for its cancer-preventing benefits.
Low-dose daily aspirin is a lifesaver, helping to prevent blood clots in the arteries supplying the heart and brain.
It is also prescribed for problems such as atrial fibrillation, a common condition that causes an irregular heartbeat, as this can also lead to the formation of blood clots. More recently, the drug has also been linked to a lower risk of cancers.
However, it does carry the risk of abdominal pain and stomach bleeds, and for this reason many patients are advised not to take it.
This risk was thought to be due to aspirin directly irritating the stomach lining and causing an ulcer. Now researchers from Nottingham University believe that helicobacter pylori bacterium (H. pylori), a common stomach bug, may in fact be responsible for the ulcers — and that aspirin merely exacerbates them.
The scientists think treating this problem at the source by eliminating the bacteria would leave more people able to tolerate aspirin, and so reduce their risk of heart attack and stroke.
One in four people is infected with H.pylori at some point, and though many people show no symptoms, it is thought to be the principal cause of stomach ulcers: about three in 20 people infected with it develop a stomach ulcer.
Now research has also linked the bacterium to bleeding from aspirin. In a study by Nottingham University, 60 per cent of patients who suffered internal bleeding while taking low-dose aspirin tested positive for the bacterium (H.pylori is detected using a breath test).
As the researchers explained: ‘Our hypothesis is that H.pylori causes the ulcer, and aspirin, by thinning the blood, makes it bleed. 'If the bacterium is eradicated, the patient will not get an ulcer and therefore there is no increased bleeding risk with aspirin.’
Now a new trial of 40,000 UK patients will investigate this. Doctors at five universities across the UK — Oxford, Durham, Southampton, Birmingham and Nottingham — will carry out the trial, the Helicobacter Eradication Aspirin Trial, starting next month and ending in March 2016.
In the study, patients aged 60 and over who are taking low-dose aspirin will first be given the breath test for the H.pylori bacterium.
Those found to be infected will receive a one-week course of eradication drug treatment of strong antibiotics, or a placebo treatment.
Commenting on the study, Dr Jonathan Lyne, a consultant cardiologist who practises in London and at the Mater Private Hospital in Dublin, said: ‘Aspirin is a cornerstone of treatment in almost all patients with vascular disease.
‘Concern in using this drug in those with a history of stomach ulceration and bleeding has always led to consideration of not using it in these patients, or using alternative drugs that may be more expensive and potentially not as effective.
‘Furthermore, the potential cost savings in preventing hospital admissions, investigations and treatments related to ulcers and bleeding caused by aspirin and H.pylori would be welcome not just to patients but to the NHS as a whole.’
Zinc supplements 'can triple the survival chances of young children with pneumonia'
These kids probably had a very poor diet in many ways. It should not be assumed that people on normal Western diets would benefit from taking zinc. Overdoses could well lead to side-effects
Zinc supplements can triple the survival chances of young children with pneumonia who are deficient in the mineral, a study has found. Taking zinc had a dramatic effect on death rates - even though it did not shorten the time severely ill children took to recover.
The metal is found in shellfish, meat, egg yolks and seeds and supports a wide range of functions in the body and is vital to the immune system.
However, many people are deficient in the mineral, both in rich and poor countries.
The new research, involving young children aged six months to five years, was conducted in Uganda where zinc deficiency is rife.
Scientists studied 352 children with severe pneumonia who were all being treated with antibiotics.
Half the children were given additional therapy in the form of 10 milligram or 20 milligram zinc supplements, depending on age.
The researchers found no difference between the two groups in the time it took to recover from infection. But the risk of dying was very different. Just 4 per cent of children taking zinc died compared with 12 per cent of those not taking zinc.
For children infected with the Aids virus, HIV, the supplements had a really dramatic impact. In this group, an extra 26 out of every 100 children had their lives saved by zinc.
Study leader Professor James Tumwine, from Makerere University in Kampala, Uganda, said: 'Zinc is known to bolster the immune system and zinc deficiency is rife all over the developed, and developing, world.
'In Uganda, where this study was performed, zinc deficiency in some areas can be as high as 70 per cent. 'We would only need to give 13 of these children with pneumonia zinc on top of their antibiotics to save one life. This equates to about four US dollars (£2.50) - a small price to pay.'
The findings are published in the online journal BMC Medicine.
The researchers pointed out that the HIV-infected children suffered a double disadvantage. Their immune systems were compromised both by HIV infection and zinc deficiency.
Taking zinc supplements was thought to give a big boost to the immune systems. Yet the scientists were unable to explain why the mineral failed to speed up recovery time.
They wrote: 'What is clear is that we have unearthed a very interesting, yet contradictory phenomenon, that seems to be related to HIV infection and severe zinc deficiency. It calls for further studies on the interaction among HIV, zinc and severe pneumonia.'