Aspirin‐induced gastric mucosal damage: prevention by enteric‐coating and relation to prostaglandin synthesis.

Abstract

1. Gastric damage induced by low‐dose aspirin and the protective effect of enteric‐coating was assessed in healthy volunteers in a double‐blind placebo‐controlled cross‐over trial using Latin square design. Each was administered placebo, plain aspirin 300 mg daily, plain aspirin 600 mg four times daily, enteric‐coated aspirin 300 mg daily, or enteric‐ coated aspirin 600 mg four times daily for 5 days. Gastric damage was assessed endoscopically, and gastric mucosal bleeding measured. 2. Aspirin 300 mg daily and 600 mg four times daily caused significant increases in gastric injury compared with placebo. Gastric mucosal bleeding was significantly more with the high dose, with a trend towards increased gastric erosions, compared with the low dose. 3. Enteric‐coating of aspirin eliminated the injury caused by low dose aspirin and substantially reduced that caused by the higher dose. 4. All dosages and formulations caused similar inhibition of gastric mucosal prostaglandin E2 synthesis. 5. Serum thromboxane levels were suppressed equally with plain and enteric‐coated aspirin. 6. In this short‐term study in healthy volunteers, gastric toxicity from aspirin was largely topical, independent of inhibition of prostaglandin synthesis, and could be virtually eliminated by the use of an enteric‐ coated preparation.

Endoscopic survey of low‐dose‐aspirin‐induced gastroduodenal mucosal injuries in patients with ischemic heart disease

“…[3][4][5] Because the majority of patients with aspirininduced gastrointestinal damage are asymptomatic, an endoscopic survey is necessary to evaluate the frequency of this side-effect. Therefore, in the present study endoscopic examination was conducted to evaluate the frequency of gastric and duodenal mucosal ulcers or erosions prospectively in low-dose aspirin users and non-users with IHD.…”

Review article: gastrointestinal bleeding with low‐dose aspirin – what's the risk?

“…grading subepithelial haemorrhage and erosions) as an outcome measure. [14][15][16][17] The clinical utility of such scales is uncertain and these studies did not provide specific information on the development of ulcers. Although these studies of low-dose aspirin do not provide completely consistent results, taken together, they suggest that lower doses, such as 75-100 mg result in a smaller increase in GI mucosal damage than higher doses, such as 300-325 mg.…”

Production of PGE2 by bovine cultured airway smooth muscle cells and its inhibition by cyclo‐oxygenase inhibitors

“…PGE2 was measured by radioimmunoassay (Hawthorne et al, 1991). Assays were performed in triplicate and expressed as pg ml'.…”