salicylates and Duodenal-Diseases

Forty endoscopically normal healthy subjects were randomized to receive either BID salsalate (3500 mg/day) or BID naproxen (750 mg/day) for 14 days followed by repeat endoscopic examination. Gastroduodenal lesions were found in 55% (11/20) of the subjects taking naproxen, and 10% (2/20) of those taking salsalate (p = 0.002). Twenty-five percent (5/20) of the subjects taking naproxen and none of the subjects taking salsalate were noted to have severe gastric injury (p = 0.003). There was no difference between the 2 groups in subjective gastrointestinal system adverse experiences. Overall, 95% (19/20) of subjects taking salsalate reported at least 1 adverse experience compared with 60% (12/20) of those taking naproxen (p = 0.02). This was due primarily to the higher number of subjects taking salsalate reporting reversible tinnitus or hearing loss. There was no significant treatment difference in adverse experiences reported for any other organ system. The results of our study support previous observations in patients with rheumatoid arthritis that salsalate produces less gastroduodenal mucosal toxicity than the widely used antiinflammatory agent, naproxen.

Topics: Alanine Transaminase; Aspartate Aminotransferases; Duodenal Diseases; Endoscopy; Gastrointestinal Diseases; Humans; L-Lactate Dehydrogenase; Liver; Naproxen; Salicylates

The aim of this double-blind endoscopic study was to compare the effects of placebo (group I, 5 patients), lysine acetylsalicylate (group II, 7 patients) and acetylsalicylic acid (group III, 7 patients) on the gastric and duodenal mucosa in healthy humans. Endoscopy was performed before and one hour after endoscopic instillation of aspirin (500 mg) or placebo in the stomach. Endoscopy was repeated after one week of aspirin-treatment (2 g per day) or placebo. Endoscopic findings were graded from 0 to 6 with regard to the aspect of the lesions (petechiae, erosions, ulcers) and to their number (less than 10; greater than 10). One hour after placebo instillation endoscopic findings were normal in all the patients of group I. Three and 5 patients of groups II and III, respectively, developed gastric lesions but none had duodenal lesions. At day 8 only one subject from group I had gastric petechiae. After one week of aspirin-treatment, 13 out of the 14 subjects of groups II and III developed gastric lesions and 3 in each group had duodenal lesions. The endoscopic score was significantly higher in group III than in group II for the following localisations: fundus, antrum, entire stomach, and stomach + duodenum. However the duodenal score was not significantly different between these 2 groups. It is concluded that, after a one-week treatment in normal patients, standard aspirin produces 2 fold more gastric mucosal damage than does soluble aspirin.

Topics: Adult; Aspirin; Double-Blind Method; Duodenal Diseases; Duodenum; Endoscopy; Female; Gastric Mucosa; Humans; Male; Salicylates; Stomach; Stomach Diseases; Time Factors

To determine whether the topical or systemic effects of aspirin are of greater importance in the production of gastroduodenal mucosal damage, the effects of regular and enteric-coated aspirin were compared in 9 healthy volunteers in a 2-week crossover endoscopic study. All subjects developed multiple gastric erosions while taking regular aspirin; 2 subjects developed one gastric erosion each while taking enteric-coated aspirin. 5 subjects developed duodenal erosions while taking regular aspirin, whereas none developed an erosion while taking enteric-coated aspirin. Mean fasting salicylate levels were similar in the two groups. It is concluded that regular aspirin causes a greater amount of gastroduodenal mucosal damage than does enteric-coated aspirin despite similar serum-salicylate levels. This suggests that the topical effects of aspirin are of greater importance than the systemic effects in the production of gastroduodenal mucosal damage in healthy subjects.

Topics: Adult; Aspirin; Duodenal Diseases; Duodenum; Erythema; Gastric Mucosa; Humans; Intestinal Mucosa; Pyloric Antrum; Salicylates; Stomach Diseases; Tablets, Enteric-Coated

From history-taking and from analysis of plasma salicylate levels it is shown that a link exists between aspirin and gastrointestinal bleeding in 68% of cases. Salicylate levels alone indicate that aspirin has been taken in 22% of cases. Plasma salicylate measurement and endoscopy allow a better understanding of haemorrhagic lesions due to aspirin. Aspirin is responsible especially for haemorrhage from ulcers and acute gastritis or duodenitis. Aspirin is seen to be dangerous in a moderate number of susceptible individuals: those with peptic ulcer constitution or cirrhosis.

Topics: Aspirin; Duodenal Diseases; Enteritis; Gastritis; Gastrointestinal Hemorrhage; Humans; Peptic Ulcer Hemorrhage; Salicylates