Causal influences in haematemesis and melaena

Jennings, G. H.

doi:10.1136/gut.6.1.1

Cited by 45 publications

(8 citation statements)

References 46 publications

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“…As well, clinical studies have implicated aspirin as a major causative agent in the development of gastric and duodenal ulcers [2,3]. Many authors have suggested that stress may play a part in the development of aspirin-induced ulcers [3,4]; a suggestion which has been vividly described by , 'that the gun must be loaded for an explosion to occur when salicylates pull the trigger'. LANGMAN [6] examined the clinical evidence for implicating both aspirin and stress in the development of gastric ulceration and concluded that the data in the literature did not support the idea that both these factors are implicated.…”

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confidence: 99%

A synergistic interaction between aspirin, or other non-steroidal anti-inflammatory drugs, and stress which produces severe gastric mucosal damage in rats and pigs

1975

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A synergistic interaction was observed in the development of damage to the gastric mucosa of rats following the administration of a single oral dose of 50 or 200 mg/kg body weight aspirin and exposure to brief periods of cold or restraint stress. Under the experimental conditions employed, the stressed (control) animals did not develop any visible signs of damage while the rats given only aspirin developed typical small erosions. However, the animals given aspirin and simultaneously exposed to stress developed a large number of deep ulcers and massive haemorrhage. Similar results were obtained in rats given a variety of non-steroidal anti-inflammatory drugs, but not with dextropropoxyphene -- an analgesic devoid of ulcerogenic activity. In pigs, the chronic administration of aspirin and exposure to restraint stress resulted in the formation of deep crater-like ulcers. Only small focal lesions were found in the pigs given aspirin alone and no mucosal damage was evident in the pigs exposed only to stress. It appears that the aspirin plus stress synergism may be the basis for the formation of chronic gastric ulcers in humans.

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A synergistic interaction between aspirin, or other non-steroidal anti-inflammatory drugs, and stress which produces severe gastric mucosal damage in rats and pigs

1975

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“…Parry and Wood 3 enjoined caution in implicating aspirin as a precipitating factor in major haemorrhage and Jennings 31 has drawn attention to the many factors potentiating the liability to gastric haemorrhage, of which aspirin is one. In the present series, of 609 patients with chronic gastric or duodenal ulcer or "acute lesions", 402 had taken aspirin recently.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Haemorrhage, Gastric Ulcer and Aspirin

Jm¹

1970

Australasian Annals of Medicine

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Summary In 1,634 admissions for acute gastroduodenal haemorrhage, the diagnosis was chronic peptic ulcer in two thirds, and “acute lesion” in one quarter. The age incidence of female gastric ulcer was bimodal, with peaks in the fifth and seventh decades. This was in conformity with previous observations of a younger group of female gastric ulcer patients in this community. A high proportion of this younger group took aspirin preparations regularly. 66% of the ulcer and "acute lesion" groups had taken aspirin before haemorrhage. However, in nearly 50% this was part of a regular habit of aspirin taking and in only 17% was it an isolated event. More of the “acute lesion” group took isolated aspirin before bleeding than the ulcer groups but the difference was not significant. The significance of isolated aspirin taking in the aetiology of acute gastroduodenal haemorrhage has been exaggerated by a failure to distinguish it from regular aspirin intake. In both males and females there was a significant association of gastric ulcer bleeding and regular aspirin consumption compared with the duodenal ulcer and “acute lesion” groups. Isolated aspirin taking occurred in those with pre‐existing ulcer as well as those with “acute lesions”.

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“…As judged by the immunity from overt haemorrhage of those who continue to take the preparation subsequently and the long duration of aspirin ingestion which precedes the bleed in some, a reasonable assumption may be that salicylates are but one of the group of noxious influences whose ability to produce the haemorrhage is to a considerable degree dependent on a concomitant favourable predisposing local state however that may be induced. Jennings (1965) emphasizes the participation of tiring journeys, rushed meals and anxiety and hostility in the production of hyperaemia, hypersecretion and hyper-motility of the stomach; such situations might render the individual unduly susceptible. During the winter of the epidemic of Asian influenza, when the public was being continuously exhorted by the various media about the beneficial and preventive properties of aspirin-containing products, no increase of hospital admissions of acute upper gastro-intestinal haemorrhage ensued (Shafar & Forgie, 1958).…”

Section: Discussionmentioning

confidence: 99%

The later clinical course of haematemesis

Shafar

Midgley

1969

Postgraduate Medical Journal

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Summary A study was conducted on the natural history of haematemesis in patients with peptic ulcer and in those with negative radiological examination, the bleed having occurred at least 5 years previously; excluded were those who had undergone emergency or interim surgery. No significant difference was found in the average severity of the bleed between the ulcer and non-ulcer groups, which were comparable in age-distributions. Routine follow-up after the haemorrhage was discontinued following correction of the post-haemorrhagic anaemia; the present haematological status was found to be satisfactory in the very great majority and it appears that the acute bleed bears little if any relationship to the process of chronic blood loss. Physical examination and liver function tests revealed no evidence of delayed hepatic damage ensuing as a consequence of transfusion. Recurrent haemorrhages occurred in similar proportions in the ulcer and non-ulcer groups; they revealed no particular time interval or features of significant distinction from those of the initial bleed. Persistence of dyspepsia showed no correlation with a bleeding tendency. There is a preponderance of blood group O in the ulcer and non-ulcer bleeders. The radiological presence of a peptic ulcer does not necessarily indicate that this is the source of the bleeding and it is suggested that the comparable features of the select group of ulcer cases of our series and the non-ulcer cases offer support to the view that the origin of the bleed in a fair proportion of instances is common to the two groups; the possibility of a derangement of the microvasculature as the operating mechanism is mooted.

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Causal influences in haematemesis and melaena

Cited by 45 publications

References 46 publications

A synergistic interaction between aspirin, or other non-steroidal anti-inflammatory drugs, and stress which produces severe gastric mucosal damage in rats and pigs

A synergistic interaction between aspirin, or other non-steroidal anti-inflammatory drugs, and stress which produces severe gastric mucosal damage in rats and pigs

Gastrointestinal Haemorrhage, Gastric Ulcer and Aspirin

The later clinical course of haematemesis

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