cardiovascular-agents and Duodenal-Ulcer

Aspirin for secondary cardiovascular disease prevention is well established, but treatment discontinuation, often because of gastrointestinal mucosal injury or symptoms, can lead to increased risk for cardiovascular events. Proton pump inhibitor therapy is recommended for aspirin-treated patients at gastrointestinal risk. PA32540 [enteric-coated aspirin (EC-ASA) 325 mg + immediate-release omeprazole 40 mg] was compared with EC-ASA 325 mg alone once daily for 6 months in 2 duplicate, randomized double-blind trials in gastrointestinal-risk patients taking aspirin for ≥3 months for secondary prevention. In this post hoc analysis, we determined the prevalence of endoscopic upper gastrointestinal ulcers at screening and whether baseline endoscopic gastric erosions impacted subsequent ulcer development. At the screening endoscopy, 6% of subjects had upper gastrointestinal ulcers (not eligible for randomization) and 40% had gastric erosions. Conditional logistic regression modeling showed that baseline gastric erosions are significantly associated with endoscopic gastric ulcer development (OR = 2.12, 95% confidence interval, 1.26-3.57). In subjects with baseline gastric erosion, 4.2% of PA32540-treated versus 13.0% of EC-ASA-treated subjects (P = 0.001) subsequently developed endoscopic gastric ulcers. These data suggest that gastric injury predisposes to gastric ulcer development when taking EC-ASA, and exposure to immediate-release omeprazole in the presence of aspirin therapy significantly reduces the likelihood of progressing to gastric ulcers.

Topics: Adolescent; Adult; Aspirin; Cardiovascular Agents; Cardiovascular Diseases; Disease Progression; Double-Blind Method; Drug Combinations; Drug Compounding; Duodenal Ulcer; Endoscopy, Gastrointestinal; Female; Gastric Mucosa; Humans; Intestinal Mucosa; Logistic Models; Male; Middle Aged; Odds Ratio; Omeprazole; Proton Pump Inhibitors; Risk Assessment; Risk Factors; Secondary Prevention; Stomach Ulcer; Tablets, Enteric-Coated; Time Factors; Treatment Outcome; Young Adult

Low-dose aspirin is used as a preventive treatment for ischemic heart disease and ischemic cerebrovascular disease, on the other hand gastrointestinal injuries are an adverse effect of aspirin. We reported that endoscopic surveillance reveals a high risk of gastroduodenal ulcer and erosion in aspirin users of ischemic heart disease. But risk of gastroduodenal injuries may be different among pre-existing disease. In the present study, endoscopic examination was performed to investigate the frequency of gastroduodenal injuries associated with low-dose aspirin in patients with cerebrovascular disease.. Routine examination using upper gastrointestinal tract endoscopy was prospectively performed for all patients admitted to Sasson Hospital for rehabilitation after cerebral infarction from April 2005 to September 2007. Endoscopic findings such as ulcers and flat erosions were assessed as mucosal injuries.. Endoscopic examination was performed for 142 successive patients, divided into three groups: 70 patients as low-dose aspirin users (aspirin group); 61 as non-aspirin users (non-aspirin group); and 11 as multi-drug users of aspirin plus other anti-platelet drugs (combination group). The aspirin group without anti-ulcer drugs (A(-) group) comprised 47 patients and the non-aspirin group without anti-ulcer drugs (NA(-) group) 31 patients. Mucosal injuries were detected in 29.8% of the A(-) group and in 6.4% of the NA(-) group (P < 0.05). The frequency of ulcer was similar between the A(-) group (6.4%) and NA(-) group (3.2%).. Endoscopy reveals low-dose aspirin-induced gastroduodenal injuries in patients with cerebral infarction.

Topics: Aged; Aged, 80 and over; Anti-Ulcer Agents; Aspirin; Cardiovascular Agents; Cerebral Infarction; Chi-Square Distribution; Duodenal Ulcer; Duodenoscopy; Duodenum; Female; Gastric Mucosa; Gastroscopy; Humans; Intestinal Mucosa; Japan; Male; Middle Aged; Prevalence; Prospective Studies; Stomach Ulcer

We investigated the incidence of upper gastrointestinal lesions in the esophagus, stomach and duodenum in patients on low-dose aspirin (LDA) therapy.. The subjects were 101 consecutive outpatients who had been on LDA therapy (average age 67.2 +/- 8.3 years; male : female ratio 3.8:1). All subjects underwent endoscopy without ceasing their antiplatelet or anticoagulant therapy. We investigated the rates of endoscopic peptic ulcer, reflux esophagitis (RE) and malignant lesion.. RE was detected in eight subjects and esophageal ulcer in one subject. The severity of RE, according to the Los Angeles classification, was grade A in one subject, B in four, C in two and D in one. All nine subjects (8.9%) with RE and esophageal ulcer were negative for Helicobacter pylori infection. Gastric ulcer was detected in 12 subjects (six H. pylori positive, six negative) and duodenal ulcer in four (one H. pylori positive, three negative). The incidence of gastroduodenal ulcer was 15.8% (16/101). The incidence of esophageal and gastric cancers was high at 5.9% (6/101). Subjects were surveyed using the gastrointestinal symptom rating scale, with no differences in scores for acid reflux, abdominal pain or indigestion according to the presence or absence of RE, gastric ulceration or duodenal ulceration.. Upper gastrointestinal mucosal injuries and neoplasm were found in not only the stomach, but also the esophagus and duodenum in LDA taking subjects. These results emphasize the importance of endoscopic surveillance in patients on LDA therapy.

Topics: Aged; Aspirin; Cardiovascular Agents; Duodenal Ulcer; Endoscopy, Digestive System; Esophageal Neoplasms; Esophagitis, Peptic; Female; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Japan; Male; Middle Aged; Pilot Projects; Severity of Illness Index; Stomach Neoplasms; Stomach Ulcer

Topics: Cardiovascular Agents; Duodenal Ulcer; Food; Fruit; Hexamethonium; Methantheline; Muscle Relaxants, Central; Oils; Olive Oil; Plant Oils; Quaternary Ammonium Compounds