Abstract
Endoscopy has become a standard method to evaluate drug-induced damage to the gastroduodenal mucosa; however, studies defining the time course, extent, and duration of the injury in man are unavailable. We report a systematic endoscopic evaluation of the effect of aspirin administration on the gastric mucosa in normal volunteers. Aspirin (2.6 g/day) or placebo was administered for 1 or 7 days. Gastroscopy was performed after 1, 2, 4, and 8 days, and every other day thereafter until the lesions resolved. Submocosal hemorrhages and/or focal erosions were present within 24 hr in all subjects. With continuous aspirin administration, injury was maximal within 3 days and then lessened, ie, damage present after 7 days of aspirin was significantly less than after 1 day of therapy. The time to resolution of the damage was also longer following 1 day than after 7 days of aspirin (median 8 days for 1 day of aspirin vs median 3 days for 7 days of aspirin). Thus, gastric mucosal adaptation occurred and was associated both with less damage and with an accelerated healing process. Acute administration of aspirin produced well-defined areas of submucosal hemorrhages within 2 hr of administration; additional doses increased the area of involvement but not necessarily the severity of involvement.
Similar content being viewed by others
References
Cooke AR: The role of acid in the pathogenesis of aspirin-induced gastrointestinal erosions and hemorrhage. Am J Dig Dis 18:225–237, 1973
Lanza FL, Royer GLJ, Nelson RS: Endoscopic evalution of the effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa. N Engl J Med 303: 136–138, 1980
Douthwaite AH, Lintott GAM: Gastroscopic observation of the effect of aspirin and certain other substances on the stomach. Lancet 2:1222–1225, 1938
Lanza FL, Royer GL Jr, Nelson RS, Chen TT, Seckman CE, Rack MF: The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers. Dig Dis Sci 24:823–828, 1979
Lanza FL, Royer GL Jr, Nelson RS, Chen TT, Seckman CE, Rack MF: A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa. Am J Gastroenterol 75:17–21, 1981
Thorsen WB Jr, Western D, Tanaka Y, Morrissey JF: Aspirin injury to the gastric mucosa. Arch Intern Med 121:499–506, 1968
Edmar D: The effects of acetylsalicylic acid on the human gastric mucosa as revealed by gastrocamera. Scand J Gastroenterol 10:495–499, 1975
Weiss A, Pitman ER, Graham EC: Aspirin and gastric bleeding. Am J Med 31:266–278, 1961
Silvoso GR, Ivey KJ, Butt JH, et al: Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 91:517–520, 1979
Caruso I, Fumagalli M, Montrone F, Vernazza M, Porro GB, Petrillo M: Controlled double-blind study comparing acetylsalicylic acid and diflunisal in the treatment of osteoarthritis of the hip and/or knee; long-term gastroscopic study.In Diflunisal in Clinical Practice, Proceedings of a Special Symposium, XIV Congress of Rheumatology. San Francisco, Futura Publishing Company, 1977, pp 63–73
Caruso I, Porro GB: Gastroscopic evaluation of anti-inflammatory agents. Br Med J 280:75–78, 1980
Irani MS: The effects of anti-inflammatory agents on the gastric mucosa in patients with osteoarthritis: Preliminary report of a randomised study. J Int Biomed Inform Data 1:21–25, 1980
Hoftiezer JW, Silvoso GR, Burks M, Ivey KJ: Comparison of the effects of regular and enteric-coated aspirin on gastroduodenal mucosa of man. Lancet 11:609–612, 1980
Snedecor GW, Cochran WG: Statistical Methods, 7th edition. Ames, Iowa, Iowa State University Press, 1980, pp 146–148
Bollman JC, Stalker LK, Mann FC: Experimental peptic ulcer produced by cinchophen. Arch Intern Med 61:119–128, 1938
Hurley JW, Crandall LA Jr: The effect of salicylates upon the stomachs of dogs. Gastroenterology 46:36–43, 1964
Hurley JW, Crandall LA Jr: The effect of various salicylates upon the dog's stomach: a gastroscopic photographic evaluation.In Salicylates, An International Symposium. A St J Dixon, BK Martin, MJH Smith, RHN Wood (eds). Boston, Little, Brown, 1963, pp 213–216
Lev R, Siegel HI, Glass GBJ: Effects of salicylates on the canine stomach: A morphological and histochemical study. Gastroenterology 62:970–980, 1972
St. John DJB, Yeomans ND, McDermott FT, de Boer WGRM: Adaptation of the gastric mucosa to repeated administration of aspirin in the rat. Am J Dig Dis 18:881–886, 1973
Eastwood GL, Quimby GF: Effect of chronic aspirin ingestion on epithelial proliferation in rat fundus, antrum, and duodenum. Gastroenterology 82:852–856, 1982
Metzger WH, McAdam L, Bluestone R, Guth PH: Acute gastric mucosal injury during continuous or interrupted aspirin ingestion in humans. Am J Dig Dis 21:963–968, 1976
MacDonald WC: Correlation of mucosal histology and aspirin intake in chronic gastric ulcer. Gastroenterology 65:381–389, 1973
Rainsford KD: Is the radiochromium-red cell technique a valid method for measuring gastrointestinal blood loss or damage following aspirin administration. Drugs Exp Clin Res 4:183–189, 1978
Kuiper DH, Overholt BF, Fall DJ, Pollard HM: Gastroscopic findings and fecal blood loss following aspirin administration. Am J Dig Dis 14:761–769, 1969
Leonards JR, Levy G, Niemczura R: Gastrointestinal blood loss during prolonged aspirin administration. N Engl J Med 289:1020–1021, 1973
Brodie DA, Tate CL, Hooke KF: Aspirin: Intestinal damage in rats. Science 170:183–185, 1970
Djaldetti M, Fishman P: The effect of aspirin on mouse small-intestinal mucosa. Arch Pathol Lab Med 105:144–147, 1981
O'Laughlin JC, Hoftiezer JW, Ivey KJ: Effect of aspirin on the human stomach in normals: Endoscopic comparison of damage produced one hour, 24 hours, and 2 weeks after administration. Scand J Gastroenterol 16(Suppl 67):211–214, 1981
Robert A: Cytoprotection by prostaglandins. Gastroenterology 77:761–767, 1979
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Graham, D.Y., Lacey Smith, J. & Dobbs, S.M. Gastric adaptation occurs with aspirin administration in man. Digest Dis Sci 28, 1–6 (1983). https://doi.org/10.1007/BF01393353
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01393353