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Coated Aspirin lowers gastric mucosal damage

Two problems, often the research has been funded by PHARMA, which in the drive for profits is eager to publicize bleeding with aspirin, but not with the other NSAIDS.  They often use lessons to suppor their findings; however, these lesion are not a good The results are often contaminated by the use of other NSAIDs in addition to aspirin.  These greatly increase the incident of gastrointestinal bleeding.  For example a Madrid study (pre-publication edition on web, by Francisco J. De Abajo, MD, M.P.H, Division de Farmacoepidemoligia y Farmacovigilamcia Agencia Espanola del Medicamento, Madrid found for 2,195 UGIC (upper gastrointestional complications) that the concomitant use of aspirin with high does NSAIDs caused a 3 fold increase.  “The concomitant use of low-does aspirin & NSAIDs at high does put patients at specially high risk of UGIC.  Published November of 2000. Another problem with PHARMA studies are that they rely upon endoscopic examination for lesions, “However, it is known that these lesions are not good predictors of major upper gastriointestional bleeding, yielding apparently opposite results” (at p. 4).  Of interest was the find that there was no dose relationship in the 75 to 300 mg range.  Since these are general taken for reduction of midocardio infractions.  It is my recommendation (JK) that the higher dose be taken so as to potentiate the cancer protective effect. 


r J Clin Pharmacol. 1991 Jul;32(1):77-83.

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Journal of Clinical Pharmacology July 1991, 32(1):77-83
Aspirin-induced gastric mucosal damage: prevention by enteric-coating and relation to prostaglandin synthesis.

Hawthorne AB, Mahida YR, Cole AT, Hawkey CJ.

Department of Therapeutics,
University Hospital, Nottingham.

Hawthorne AB, Mahida YR, Cole AT, Hawkey CJ.

Department of Therapeutics, University Hospital, Nottingham.

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.




Regular, high dosage usage of aspirin for rheumatic disease; the ulcer incidents was only one fourth for those who took enteric aspirin.


Ann Intern Med. 1979 Oct;91(4):517-20.

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Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy.

Silvoso GR, Ivey KJ, Butt JH, Lockard OO, Holt SD, Sisk C, Baskin WN, Mackercher PA, Hewett J.

Endoscopy was done in 82 patients with rheumatic disease who were receiving chronic aspirin therapy. Fifty-eight patients were taking at least eight aspirin tablets daily for 3 or more months; 24 patients were taking, in addition to the aspirin, a maximum of one other antiinflammatory, nonsteroidal medication. Endoscopy in 45 normal subjects not taking aspirin showed no ulcers or erosions and a 4% incidence of gastric erythema. In the 82 patients with rheumatic disease, 14 (17%) had gastric ulcers, 33 (40%) had gastric erosions, and 62 (76%) had gastric erythema. Regular aspirin and buffered aspirin users had an ulcer incidence of 23% and 31% respectively, compared with a 6% incidence in enteric-coated aspirin users (P less than 0.05). One third of all patients with gastric ulcer had no gastrointestinal symptoms. Patients taking chronic aspirin therapy for rheumatic diseases have a higher than suspected incidence of gastric ulcer and erosions. Gastric ulcer may exist without symptoms in such patients.



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Disclaimer:  The information, facts, and opinions provided here is not a substitute for professional advice.  It only indicates what JK believes, does, or would do.  Always consult your primary care physician for medical advice, diagnosis, and treatment.