Abolition by omeprazole of aspirin induced gastric mucosal injury in man.

Abstract

This study investigates whether aspirin injury to the human gastric mucosa can be prevented by profound acid suppression with omeprazole, in a randomised, double blind, crossover design according to latin square. It was concluded that profound acid suppression can prevent aspirin induced gastric mucosal injury in normal subjects. This approach may prevent the development of peptic ulcers and their complications in patients taking aspirin and other non-steroidal anti-inflammatory drugs.Aspirin and non-steroidal anti-inflammatory drugs are strongly associated with peptic ulcer complications in the elderly in Britain. Assuming that the association may be causative, a number of approaches have tried to reduce the extent of damage caused by these agents.6 Although old people appear to be at greatest risk, it is difficult to evaluate possible therapeutic manoeuvres in this population. We have therefore investigated healthy adult volunteers whose acute responses appear to reflect those of older patients.7 Our previous studies show that acid inhibition by ranitidine8 and famotidine9 results in a reduction in gastric mucosal damage, as quantified by the rate of gastric mucosal bleeding and endoscopic appearance, but aspirin induced damage was not totally abolished.In the present study we have examined the hypothesis that gastric acid is necessary for the occurrence of aspirin induced gastric damage. To achieve virtual gastric anacidity we used omeprazole, an irreversible inhibitor of the proton pump in gastric parietal cells.'0 Methods bd for the last 48 h; (c) omeprazole 20 mg each morning for seven days plus aspirin 900 mg bd for the last 48 h; and (d) omeprazole 40 mg bd for seven days plus aspirin 900 mg bd for the last 48 h. The last doses of omeprazole and aspirin (or the corresponding placebo) were taken at 07 00 h and 07 30 h -that is, 120 and 90 minutes, respectively, before measurement of gastric blood loss. Each of the above regimens was separated by a seven day washout period. The order of treatments was randomised according to a latin square design and the study conducted in double blind manner.

Primary Prevention of Adverse Gastroduodenal Effects from Short-Term Use of Non-Steroidal Anti-Inflammatory Drugs by Omeprazole 20 mg in Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled Study

“…These results extend the results of other, smaller and/or non-controlled studies of primary prevention by PPIs of short-term non-selective NSAID-related GI side effects [31]. Most such studies have utilized aspirin (ASA) [32][33][34][35][36][37][38][39]. The available evidence suggests that OMP results in an approximately 75% decrease in the incidence of endoscopic lesions related to either low-dose or antiinflammatory dose of ASA daily [32,37].…”

Adjuvant Aspirin Therapy Reduces Symptoms of Schizophrenia Spectrum Disorders

“…At least 2 randomized, controlled trials have demonstrated that mucosal gastric injury from aspirin at similar or higher doses than those used in our study can be abolished by adjuvant use of the proton pump inhibitor omeprazole. 40,41 We therefore take the position that the gastrointestinal bleeding risk of high-dose aspirin is acceptable, provided that a proton pump inhibitor is additionally prescribed. This was supported by the fact that no serious gastric or bleeding events requiring medical attention were observed in our trial.…”

Reducing Clinically Significant Gastrointestinal Toxicity Associated with Nonsteroidal Antiinflammatory Drugs

“…41 Additionally, one small trial of short duration found that omeprazole 20 -40 mg/day decreased the incidence of high-dose aspirin-induced gastric mucosal bleeding compared with placebo. 39 Lai et al 42 evaluated the efficacy of lansoprazole in preventing recurrent ulcer complications in 123 patients with eradicated H. pylori infection and a previous history of ulcer complications due to low-dose aspirin (100 mg/day). Patients continued on aspirin 100 mg/day and received either lansoprazole 30 mg/day or placebo for 12 months.…”