Skip to main content
PMC home page
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1991 Jul;32(1):77–83. doi: 10.1111/j.1365-2125.1991.tb05616.x

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

A B Hawthorne 1, Y R Mahida 1, A T Cole 1, C J Hawkey 1
PMCID: PMC1368496  PMID: 1888645

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.

Full text

PDF
79

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong C. P., Blower A. L. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut. 1987 May;28(5):527–532. doi: 10.1136/gut.28.5.527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beard K., Walker A. M., Perera D. R., Jick H. Nonsteroidal anti-inflammatory drugs and hospitalization for gastroesophageal bleeding in the elderly. Arch Intern Med. 1987 Sep;147(9):1621–1623. [PubMed] [Google Scholar]
  3. Carson J. L., Strom B. L., Soper K. A., West S. L., Morse M. L. The association of nonsteroidal anti-inflammatory drugs with upper gastrointestinal tract bleeding. Arch Intern Med. 1987 Jan;147(1):85–88. [PubMed] [Google Scholar]
  4. Collins A. J., Du Toit J. A. Upper gastrointestinal findings and faecal occult blood in patients with rheumatic diseases taking nonsteroidal anti-inflammatory drugs. Br J Rheumatol. 1987 Aug;26(4):295–298. doi: 10.1093/rheumatology/26.4.295. [DOI] [PubMed] [Google Scholar]
  5. Cooke A. R., Goulston K. Failure of intravenous aspirin to increase gastrointestinal blood loss. Br Med J. 1969 Aug 9;3(5666):330–332. doi: 10.1136/bmj.3.5666.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ehsanullah R. S., Page M. C., Tildesley G., Wood J. R. Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine. BMJ. 1988 Oct 22;297(6655):1017–1021. doi: 10.1136/bmj.297.6655.1017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Farah D., Sturrock R. D., Russell R. I. Peptic ulcer in rheumatoid arthritis. Ann Rheum Dis. 1988 Jun;47(6):478–480. doi: 10.1136/ard.47.6.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Faulkner G., Prichard P., Somerville K., Langman M. J. Aspirin and bleeding peptic ulcers in the elderly. BMJ. 1988 Nov 19;297(6659):1311–1313. doi: 10.1136/bmj.297.6659.1311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. GROSSMAN M. I., MATSUMOTO K. K., LICHTER R. J. Fecal blood loss produced by oral and intravenous administration of various salicylates. Gastroenterology. 1961 Mar;40:383–388. [PubMed] [Google Scholar]
  10. Graham D. Y., Smith J. L. Aspirin and the stomach. Ann Intern Med. 1986 Mar;104(3):390–398. doi: 10.7326/0003-4819-104-3-390. [DOI] [PubMed] [Google Scholar]
  11. Graham D. Y., Smith J. L., Spjut H. J., Torres E. Gastric adaptation. Studies in humans during continuous aspirin administration. Gastroenterology. 1988 Aug;95(2):327–333. [PubMed] [Google Scholar]
  12. Hoftiezer J. W., O'Laughlin J. C., Ivey K. J. Effects of 24 hours of aspirin, Bufferin, paracetamol and placebo on normal human gastroduodenal mucosa. Gut. 1982 Aug;23(8):692–697. doi: 10.1136/gut.23.8.692. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ivey K. J., Paone D. B., Krause W. J. Acute effect of systemic aspirin on gastric mucosa in man. Dig Dis Sci. 1980 Feb;25(2):97–99. doi: 10.1007/BF01308304. [DOI] [PubMed] [Google Scholar]
  14. Lanza F. L., Royer G. L., Jr, Nelson R. S. Endoscopic evaluation of the effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa. N Engl J Med. 1980 Jul 17;303(3):136–138. doi: 10.1056/NEJM198007173030305. [DOI] [PubMed] [Google Scholar]
  15. Larkai E. N., Smith J. L., Lidsky M. D., Graham D. Y. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 1987 Nov;82(11):1153–1158. [PubMed] [Google Scholar]
  16. Ligumsky M., Sestieri M., Karmeli F., Zimmerman J., Okon E., Rachmilewitz D. Rectal administration of nonsteroidal antiinflammatory drugs. Effect on rat gastric ulcerogenicity and prostaglandin E2 synthesis. Gastroenterology. 1990 May;98(5 Pt 1):1245–1249. [PubMed] [Google Scholar]
  17. Montgomery P. R., Sitar D. S. Acetylsalicylic acid metabolites in blood and urine after plain and enteric-coated tablets. Biopharm Drug Dispos. 1986 Jan-Feb;7(1):21–25. doi: 10.1002/bdd.2510070104. [DOI] [PubMed] [Google Scholar]
  18. Peto R., Gray R., Collins R., Wheatley K., Hennekens C., Jamrozik K., Warlow C., Hafner B., Thompson E., Norton S. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J (Clin Res Ed) 1988 Jan 30;296(6618):313–316. doi: 10.1136/bmj.296.6618.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Prichard P. J., Kitchingman G. K., Walt R. P., Daneshmend T. K., Hawkey C. J. Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin. BMJ. 1989 Feb 25;298(6672):493–496. doi: 10.1136/bmj.298.6672.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Somerville K., Faulkner G., Langman M. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer. Lancet. 1986 Mar 1;1(8479):462–464. doi: 10.1016/s0140-6736(86)92927-2. [DOI] [PubMed] [Google Scholar]
  21. Whittle B. J. Temporal relationship between cyclooxygenase inhibition, as measured by prostacyclin biosynthesis, and the gastrointestinal damage induced by indomethacin in the rat. Gastroenterology. 1981 Jan;80(1):94–98. [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES