NSAIDs, migraines and H pylori

Short of time for reading through the journals? Dr Suzanne Hunter guides you through the latest research

Research of the week

An aspirin a day keeps the surgeon away
Lancet 2007; 396: 1,603–13

It has been shown in previous short-term studies that aspirin can prevent the reoccurrence of bowel adenomas, which of course can turn into carcinomas.

What this long-term trial showed is that aspirin can reduce the incidence of colorectal cancer itself. Aspirin at a dose of 300mg daily needed to be taken for at least five years, and it is 10 years before the effect is noticed. It may be that lower or less frequent dosage would also do the trick, but the data is not there.

Preventing NSAID re-bleeds
Lancet 2007; 369: 1,621–26

It is well known that NSAIDs can cause peptic ulcers and high-risk individuals who need this analgesia should take their NSAID with a PPI (or a Cox-2 inhibitor if you can sneak it past the primary care organisation’s pharmaceutical adviser).

This piece of research in Hong Kong is going to induce stomach ulceration in pharmaceutical advisers. The conclusion after a randomised double-blind trial on patients who had had a GI bleed and who still needed an NSAID was that they should have a Cox-2 and a PPI. Those who received this combination had no re-bleeds in 13 months while 9 per cent did in those who only had a Cox-2. They recommend a rethink on guidelines.

Migraine increases MI risk

Arch Intern Med 2007; 167: 795–801

Migraine is common — with 18 per cent and 6 per cent of the female and male population suffering respectively. It has been suggested that there is a connection between migraine and cardiovascular disease (CVD). This was examined in 20,000 men from the Physician’s Health Study. All were free of CVD at the beginning of the study.

After 16 years, those who suffered migraines had a 1.24 increased risk of a major CVD event over non-migraineurs and an increased risk of 1.12 of ischaemic stroke. However, what you do about this risk I am not too sure; this avenue of enquiry is not entered into in this study.

H pylori and asthma protection
Arch Intern Med 2007; 167: 821–7

H pylori has been in our guts for thousands of years and is endemic in adults in developing countries, but the prevalence is much lower in developed countries where, as we all know, the incidence of atopy is rising.

This study compared the presence of H pylori to the onset and incidence of atopic orders. They found an inverse association of H pylori positivity with ever having asthma (odds ratio 0.79) and an even stronger inverse association with childhood-onset asthma (odds ratio 0.63). There was a similar relationship for allergic rhinitis.

The exact mechanisms by which this happens are unclear but perhaps this goes some way towards explaining the rise of allergies in the ‘hygienic’ developed world. It is unsurprising that something endemic in the developing world, where conditions are more similar to those in which we evolved, should play a role in our well-being.

Referrals for headache
Br J Gen Pract 2007; 57: 388–95

Headache is the most common neurological presentation in general practice and the most common referral to neurologists, with a third of the outpatient workload taken up with this complaint. This study investigated the differences between headache patients who are referred and those managed in primary care.

While headache patients can have severe symptoms there is no difference in these parameters between those referred and those not. The difference is that those referred are more anxious about their headaches, make stronger emotional representations, attribute more symptoms to their headaches and also consult more frequently generally. In other words they are referred because they ask to be.

However, for me, the two biggest things to come out of this study were the statistics that only 2 per cent of headaches are referred while 98 per cent are managed by us, and the rest of Europe has 10 times the number of neurologists per head of population compared with the UK.

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals

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