salicylates and Gastrointestinal-Hemorrhage

The classical aim of the treatment of ulcerative colitis is to induce and maintain remission. However, this aim has not been shown to prevent long-term complications. Current treatment goals attempt to prevent complications. In some studies, healing of the intestinal mucosa has been shown to improve long-term outcomes. In ulcerative colitis, mucosal healing reduces recurrence, the risk of colorectal cancer and the need for surgery, and improves patients' quality of life. The drugs for which there is greatest evidence of their efficacy in inducing and maintaining mucosal healing are salicylates and biological agents. In the near future, endoscopic monitoring may be required to evaluate response to the treatment and decisions may have to be taken according to the persistence or disappearance of these lesions.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Biological Therapy; Colectomy; Colitis, Ulcerative; Colorectal Neoplasms; Combined Modality Therapy; Disease Progression; Gastrointestinal Hemorrhage; Humans; Immunosuppressive Agents; Intestinal Mucosa; Outcome Assessment, Health Care; Prognosis; Quality of Life; Recurrence; Regeneration; Salicylates; Severity of Illness Index

Interactions of salicylates with the hematopoietic system are reviewed. Development of anemia is discussed with respect to fluid retention, gastrointestinal bleeding, and hemolytic anemia. Alterations in polymorphonuclear leukocyte and platelet function are evaluated. Interactions with anticoagulants and with the coagulation system are identified.

Topics: Aspirin; Blood Platelets; Gastrointestinal Hemorrhage; Hematologic Diseases; Hematopoietic System; Hemolysis; Hemostasis; Humans; Leukocytes; Salicylates

The mechanism(s) of salicylate-induced damage of the gastric mucosa is complex. The presence of acid in the lumen is essential for the occurrence of such injury. Although the absorption of salicylate is greater in the presence of acid, salicylate can selectively increase cation permeability both in the absence and presence of acid. Recent studies suggest that this permits increased diffusion of luminal acid into the tissue, which leads to major permeability changes of the mucosa. Salicylate also affects metabolic processes of the gastric mucosa, which appear to be independent of the increased diffusion of acid into the tissue also caused by salicylate. The release of histamine, which has been shown to occur in vivo as a result of mucosal damage, does not appear to intensify existing mucosal injury in an isolated system.

Topics: Animals; Biological Transport, Active; Chlorides; Diffusion; Gastric Juice; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Hydrogen-Ion Concentration; Permeability; Salicylates; Sodium

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Benzothiadiazines; Blood Glucose; Blood Platelets; Diuretics; Drug Interactions; Fluorobenzenes; Gastrointestinal Hemorrhage; Hearing Disorders; Humans; Hypoglycemic Agents; Kinetics; Male; Prostaglandins; Salicylates; Sodium Chloride Symporter Inhibitors; Time Factors; Uric Acid

"Aspirin" is the most widely used medication which is considered to be safe and effective, and which can be obtained universally without prescription. A review of the literature and clinical experience reveal that many complications can be attributed to the prolonged use of it. Some of these complications involve damage to various tissues and organs (particularly the gastric mucosa, the renal papilla, red blood cells, and the inner ear) and to coagulation and body temperature control. Hemorrhagic gastritis may result with as little as 600 mg. of salicylate four times a day for 5 days. Papillitis of the renal system may result from a comparable dosage of aspirin compound mediates with phenacetin. The purpose of this article has been to call attention to some of the important complications which may result from salicylate abuse. It is hoped that many of these complications may be avoided by proper and effective indoctrination of patients to the hazards associated with prolonged or indiscriminate intake of salicylates.

Topics: Acid-Base Equilibrium; Aspirin; Blood Coagulation; Blood Platelets; Carbon Dioxide; Digestive System; Ear, Inner; Fever; Gastric Mucosa; Gastrointestinal Hemorrhage; Homeostasis; Humans; Kidney; Kidney Papillary Necrosis; Phenacetin; Salicylates

Topics: Age Factors; Alcohol Drinking; Animals; Anti-Inflammatory Agents; Ascorbic Acid Deficiency; Aspirin; Blood Group Antigens; Female; Food; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Hydrogen-Ion Concentration; Male; Nutritional Physiological Phenomena; Particle Size; Permeability; Prostaglandins; Regional Blood Flow; Salicylates; Sex Factors; Stomach Diseases; Stomach Ulcer; Structure-Activity Relationship

Topics: Adrenocorticotropic Hormone; Aged; Aminopyrine; Animals; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Aspirin; Dogs; Drug Hypersensitivity; Duodenal Ulcer; Esophageal Diseases; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Glucocorticoids; Humans; Hydrocortisone; Indomethacin; Intestinal Mucosa; Osteoarthritis; Penicillins; Phenylbutazone; Prednisolone; Rats; Rheumatic Diseases; Salicylates; Sodium Salicylate; Stomach Diseases; Stomach Ulcer; Streptomycin

Topics: Animals; Anticoagulants; Ascorbic Acid Deficiency; Aspirin; Cats; Gastric Juice; Gastric Mucosa; Gastrointestinal Hemorrhage; Gastroscopy; Hemorrhagic Disorders; Histamine; Humans; Occult Blood; Pepsin A; Rats; Salicylates; Time Factors; Vagotomy; Vagus Nerve; von Willebrand Diseases

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Arthritis, Rheumatoid; Erythrocyte Count; Folic Acid Deficiency; Gastrointestinal Hemorrhage; Hemolysis; Humans; Iron; Plasma Volume; Salicylates; Vitamin B 12 Deficiency

Calcium antagonists were found to be associated with an increased risk of gastrointestinal haemorrhage (GIH) in hypertensive patients over 67 years old (Pahor et al. Lancet 1996; 347 : 1061). This unexpected result led us to investigate this question using the French pharmacovigilance system database. We use the case/non case methodology (Moore et al. Br J Pharmacol 1997; 44 : 513) where cases and non cases were both identified from the spontaneous adverse drug reaction (ADR) reporting database. Cases were reports of the reaction of interest (i.e. GIH as recorded in the database). Non cases were all reports of reactions other than being studied. Exposure was considered as the presence in a report of the drug of interest (calcium antagonists), whether or not it was suspected of causing the reaction. We calculated Odds ratios (OR) as the ratio of the Odds of the association of reports of GIH with calcium antagonists in cases and in non cases. Calcium antagonists included in the present study were dihydropyridines, diltiazem, verapamil and bepridil. Salicylates and non steroidal antiinflammatory drugs were used as positive controls. Among the 112,792 ADRs recorded in the database between January 1985 and December 1996, 864 (0.8%) were GIH. There was no association between GIH and the exposure to calcium antagonists whatever the class of the drugs (OR = 1.2, 95% CI: [0.9; 1.6]. A subgroup analysis among the GIH reported in patients over 65 years old (470 GIH from 37,462 ADRs) also failed to find any association (OR = 0.7, 95% CI: [0.5-1.0%]). The present results failed to confirm the hypothesis of an association between GIH and use of calcium antagonists.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Calcium Channel Blockers; Gastrointestinal Hemorrhage; Humans; Hypertension; Pharmacoepidemiology; Risk Factors; Salicylates

We evaluated whether therapy designed to eradicate Helicobacter pylori infection resulted in a reduction in rebleeding in patients with peptic ulcer disease. Patients presenting because of major upper gastrointestinal hemorrhage from peptic ulcer and whose ulcers healed in a study in which they were randomized to receive ranitidine alone or triple therapy plus ranitidine were followed up regularly with endoscopy. No maintenance anti-ulcer therapy was given after ulcer healing.. Patients received ranitidine, 300 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2 g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet), and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given. Development of ulcer recurrence with or without recurrent upper gastrointestinal bleeding was evaluated.. Thirty-one patients with major upper gastrointestinal bleeding from peptic ulcer were studied; 17 received triple therapy and 14 ranitidine alone. Major rebleeding occurred significantly (p = 0.031) more often in those in the ranitidine group (28.6%), compared with none (0%) in the triple therapy group.. Eradication of H. pylori infection reduces the rate of ulcer recurrence and rebleeding in complicated ulcer disease.

Topics: Adult; Aged; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Gastrointestinal Hemorrhage; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Peptic Ulcer; Prospective Studies; Ranitidine; Recurrence; Salicylates; Tetracycline

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.

Topics: Adult; Aspirin; Dinoprostone; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Male; Salicylates; Stomach Diseases; Tablets, Enteric-Coated; Thromboxane B2

Enprostil is a synthetic dehydro-prostaglandin E2 with gastroduodenal ulcer-healing and mucosal-protective properties. One hundred and three healthy volunteers were randomized to receive capsules of enprostil 35 micrograms b.d. (the clinically recommended dose), enprostil 70 micrograms b.d., or placebo b.d. All underwent endoscopic assessment of the gastroduodenal mucosa, scored using a 0-4 scale, at baseline and on Days 3, 7, 14, 21 and 28 of dosing. Mean and median maximum scores demonstrated a dose response, and the mean maximum scores were statistically significantly higher for both enprostil groups on each endoscopy day when compared with placebo. The majority of enprostil-treated subjects had petechial haemorrhages. The proportion of volunteers with small white-based mucosal breaks (erosions) was significantly higher for the fundus in the enprostil 70-microgram group on Days 21 and 28 when compared with placebo, but there were no significant differences between treatment groups for any area on the other study days. The 70-microgram dose was associated with significantly more gastrointestinal adverse events than the 35-microgram dose, which was similar to placebo. There were no significant differences between groups for large white-based mucosal breaks (ulcers). We conclude that oral enprostil produced gastric mucosal petechial haemorrhages, primarily in the fundus of the stomach. Gastric mucosal petechial haemorrhages are probably without clinical significance because they are very common in the general population (10-15%) and do not progress to erosions and ulcers.

Topics: Double-Blind Method; Duodenum; Enprostil; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Intestinal Mucosa; Male; Reference Values; Salicylates; Salicylic Acid; Stomach Ulcer

The effects of diflunisal, a nonacetylated difluorinated salicylate, on platelet function were compared with those of aspirin and placebo. In a randomized, double-blind trial, normal subjects were given diflunisal, 250, 500, or 1,000 mg twice daily; aspirin, 650 or 1,300 mg twice daily; or placebo for 8-day periods. Difunisal, 250 mg, had no effect on platelet function, whereas 500 mg induced minimal inhibition of colagen-induced release of platelet serotonin, and 1,000 mg inhibited platelet malondialdehyde production, moderately prolonged template bleeding times (P = NS), and increased fecal blood loss (P less than 0.05). In contrast, aspirin, 650 mg, markedly inhibited collagen-induced platelet aggregation and serotonin release, and 1,300 mg prolonged bleeding time (P less than 0.01) and increased fecal blood loss (P less than 0.01). The effects of aspirin lasted for up to 5 days, whereas changes induced by diflunisal had returned to baseline 24 hr after the drug was discontinued. We conclude that in doses in the same range as those of aspirin diflunisal inhibits platelet function less.

Topics: Adult; Aspirin; Blood Platelets; Diflunisal; Double-Blind Method; Feces; Female; Gastrointestinal Hemorrhage; Humans; Male; Malondialdehyde; Placebos; Platelet Aggregation; Platelet Function Tests; Random Allocation; Salicylates; Time Factors

Eleven patients suffering from arthritis received, in a randomized cross-over study, anti-inflammatory doses of two aspirin formulations: Enpryn, capsules containing enteric-coated pellets; Rhusal, an enteric-coated tablet. No significant difference was found between the two formulations with respect to gastrointestinal microbleeding, plasma salicylate levels and urinary recovery of salicylate. Bioavailability studies carried out on 10 healthy male volunteers demonstrated that absorption from the enteric-coated pellet capsules was sustained and complete.

Topics: Aspirin; Biological Availability; Gastrointestinal Hemorrhage; Humans; Salicylates; Tablets, Enteric-Coated

Topics: Adult; Diflunisal; Gastrointestinal Hemorrhage; Humans; Male; Occult Blood; Random Allocation; Salicylates

In a first stage the effect of a single dose of 3 g of salsalate on serum salicylate level was compared with a single intake of 3 g of soluble or enteric-coated acetylsalicylates in 12 healthy subjects. Salsalate seems to resorb faster than the enteric-coated forms but more slowly than the soluble forms of acetylsalicylate. However, in comparison with these latter forms, salsalate activity is more protracted. In the second part of the study, 42 patients were admitted to a trial in which 3 to 5 g of salsalate was given daily and in which serum salicylate levels and blood loss in stools were measured using the method of labelling red blood cells with Cr51. The ideal dosage to obtain a serum salicylate level of 20 mg/100 ml seems to lie between 3 and 4 g of salsalate a day. Salsalate caused abnormal gastro-intestinal blood loss in only 2 of the 42 patients studied, which is significantly fewer compared with the soluble, intravenous or enteric-coated forms of acetylsalicylates.

Topics: Aspirin; Clinical Trials as Topic; Female; Gastrointestinal Hemorrhage; Humans; Male; Salicylates

Topics: Acetaminophen; Aspirin; Gastrointestinal Hemorrhage; Humans; Salicylates

Using a placebo-controlled methodology, 20 healthy volunteers housed in a clinical research facility for 23 days were studied for fecal blood loss and plasma salicylate levels after taking salsalate (salicylsalicylic acid) or aspirin. Daily dosages were 3000 mg salsalate or 3900 mg aspirin. Aspirin produced statistically significant gastrointestinal blood loss over control levels and over that produced by salsalate (P less than 0.01). Blood loss with salsalate was not different than that with placebo. Despite the intentional disparity of dosages between the two drugs, plasma salicylate levels were not statistically different. Side effects occurred at about equal frequency with either drug. Most prominent were headache and nausea. However, concomitant upper respiratory infection in 12 subjects rendered interpretation difficult.

Topics: Adult; Aspirin; Chromium Radioisotopes; Female; Gastrointestinal Hemorrhage; Humans; Liver; Male; Placebos; Salicylates; Time Factors

In a double-blind trial of tranexamic acid in massive upper gastrointestinal haemorrhage, 76 patients were treated with the active drug and 73 patients with placebo. The doses were 1 g intravenously six times daily for a maximum of 3 days, followed by 1.5 g orally four times daily for a maximum of 4 days. The treatment group and the placebo group were comparable with respect to mean age, diagnoses and laboratory tests but differed slightly with respect to sex and alcohol consumption. The transfusion requirement in the treatment group was less than in the placebo group during the first days after admission, the difference being significant on the second day after admission. Ten patients in the treatment group and 18 patients in the placebo group were operated on. Eleven patients in the treatment group and 12 patients in the placebo group died. In the tranexamic-acid-treated group fewer operations were performed and significantly less blood was needed. It therefore seems highly likely that tranexamic acid has a beneficial effect, although small.

Topics: Aged; Alcohol Drinking; Blood Transfusion; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Gastrointestinal Hemorrhage; Hemoglobins; Humans; Male; Middle Aged; Placebos; Prothrombin; Random Allocation; Salicylates; Thromboembolism; Tranexamic Acid

Fecal blood loss was evaluated in normal subjects with 51Cr-labeled red cells. In a double-blind parallel study in 10 subjects, 250 mg diflunisal twice daily did not significantly increase blood loss in two consecutive treatment periods, while 750 mg acetylsalicylic acid (ASA) 4 times daily did so. In a double-blind crossover study in 2 subjects, diflunisal, 250 mg twice daily again did not significantly affect fecal blood loss during a 4-day treatment period, and there also was no significant effth diflunisal during two additional treatment days. ASA, 600 mg 4 times daily, induced an increase in blood loss and this effect was significantly enhanced by the addition of alcohol. The difference between treatments in the way they interact with alcohol was also statistically significant.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Clinical Trials as Topic; Double-Blind Method; Drug Interactions; Ethanol; Gastrointestinal Hemorrhage; Humans; Male; Salicylates

The effect of enteric coating of aspirin tablets on the gastrointestinal blood loss associated with high dose aspirin therapy was investigated in 12 patients with rheumatoid arthritis. Occult blood loss was measured after labelling the patients' red blood cells with Cr51. Three salicylate preparations were used: enteric coated tablets of aspirin ("Rhusal", G.P. Laboratories, 7 x 650 mg per day), uncoated tablet cores of aspirin from the same batch (7 x 650 mg per day) and enteric coated tablets of sodium salicylate (7 x 600 mg and 1 x 300 mg per day). Daily blood loss during a salicylate-free period was (0.7 +/- 0.15 ml, mean +/- SE). Blood loss was significantly increased during dosage with all three salicylate preparations. Daily blood loss during dosage with the uncoated tablets of aspirin (5.3 +/- 0.3 ml) was significantly greater than during dosage with the enteric coated tablets of aspirin (2.3 +/- 0.3 ml) and enteric coated tablets of sodium salicylate (2.1 +/- 0.4 ml). The bioavailability of the salicylate preparations was studied in seven of the 12 patients. Mean plasma salicylate concentration two hours after the second daily dose during dosage with the enteric coated tablets of aspirin was 118 +/- 15 microgram/ml compared to 131 +/- 16 microgram/ml during dosage with the uncoated tablets. Urinary recoveries of the daily dosage of aspirin in the two formulations were also similar.

Topics: Aged; Aspirin; Biological Availability; Clinical Trials as Topic; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Occult Blood; Salicylates; Tablets, Enteric-Coated

64 patients with rheumatoid arthritis (R.A.) entered the trial: 40 of them still remain on medication; 28 have so far completed 2 years; 23, 3 years; 12, 4 years using D-2-(6'-methoxy-2'-naphthyl)-propionic acid (naproxen) as the principal anti-inflammatory agent. Tolerance has been good: side effects or complaints, when reported, were mild and transient in nature. Close monitoring of a range of biochemical values by sequential laboratory studies has not revealed naproxen to have many adverse effects. After two years of daily continuous naproxen administration, 19 volunteer patients were subjected to a short-term double-blind cross-over placebo experiment. The results were in favor of a continued therapeutic efficacy of naproxen. The possible gastrointestinal bleeding found in the majority of anti-inflammatory drugs has been studied on 12 volunteers using 51-Cr. Naproxen exhibited a mean G.I. blood loss comparable to placebo or to physiological blood loss in normal volunteers. The conclusion drawn is that naproxen shows a good therapeutic index.

Topics: Adult; Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Chromium Radioisotopes; Clinical Trials as Topic; Drug Evaluation; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Long-Term Care; Male; Middle Aged; Naphthaleneacetic Acids; Naproxen; Placebos; Salicylates

Topics: Adenosine Diphosphate; Adult; Analysis of Variance; Aspirin; Blood Cell Count; Blood Coagulation; Clinical Trials as Topic; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Naphthalenes; Occult Blood; Placebos; Platelet Adhesiveness; Propionates; Prothrombin Time; Salicylates; Time Factors

In a double-blind between-patient study of aspirin and benorylate carried out in 72 outpatients with rheumatoid arthritis, benorylate 4 g twice daily was shown to be an effective analgesic and anti-inflammatory drug, its effects being indistinguishable from those of aspirin 1.2 g four times daily. Compared with the pretreatment values both drugs produced a statistically significant improvement (P < 0.01) in functional grade, overall pain, articular index, and grip strength at the end of the first and second weeks. The overall incidence of side effects was less with benorylate, though this difference was not significant at the 5% level.

Topics: Adolescent; Adult; Aged; Analgesics; Aniline Compounds; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Aspirin; Clinical Trials as Topic; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Movement; Pain; Phenols; Physical Examination; Salicylates; Tinnitus

Topics: Absorption; Achlorhydria; Adult; Chlorides; Clinical Trials as Topic; Diffusion; Female; Gastric Mucosa; Gastritis; Gastrointestinal Hemorrhage; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Male; Potassium; Salicylates; Sodium

Benorylate (4-acetamidophenyl 2-acetoxybenzoate) is a new esterified aspirin preparation whose antirheumatic properties are reported to be as good as those of aspirin. Gastrointestinal blood loss, measured with (51)Cr-labelled red cells, during benorylate therapy was compared with that during therapy with soluble aspirin in 15 subjects, a simplified crossover procedure being used. Mean blood loss during benorylate therapy was 1.7 ml/day which was significantly less than that during therapy with soluble aspirin (5.1 ml/day; P <0.001). In 12 of the 15 patients blood loss with benorylate was less than 2.5 ml/day. Benorylate appears to be a definite improvement on current formulations of aspirin and should be a useful drug for the treatment of patients with chronic rheumatic disorders.

Topics: Acetanilides; Acetates; Adult; Aged; Analgesics; Chromium Isotopes; Chronic Disease; Clinical Trials as Topic; Feces; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Occult Blood; Rheumatic Diseases; Salicylates; Solubility

Topics: Aspirin; Clinical Trials as Topic; Gastric Mucosa; Gastrointestinal Hemorrhage; Gastroscopy; Heartburn; Humans; Photography; Placebos; Salicylates; Tinnitus

Topics: Aminobenzoates; Arthritis, Rheumatoid; Aspirin; Blood Coagulation; Buffers; Dyspepsia; Gastritis; Gastrointestinal Hemorrhage; Humans; Intestinal Absorption; Kidney Diseases; Placebos; Salicylates; Sodium Salicylate; Tablets, Enteric-Coated

Topics: Adult; Aspirin; Chromium Isotopes; Clinical Trials as Topic; Feces; Female; Gastrointestinal Hemorrhage; Humans; Male; Placebos; Salicylates

Topics: Adult; Aged; Aluminum; Aspirin; Caffeine; Carbonates; Chromium Isotopes; Citrates; Digestive System; Gastrointestinal Hemorrhage; Humans; Magnesium; Middle Aged; Phenacetin; Placebos; Potassium Chloride; Proteins; Salicylates; Serum Albumin

This study aimed to determine the incidence, as well as evaluate risk factors, and impact of gastrointestinal bleeding on outcomes and resource use in patients admitted for salicylate poisoning.. We used the National Inpatient Sample to construct a cohort of patients hospitalized primarily for salicylate poisoning from 2003 to 2014. We compared clinical characteristics, in-hospital treatments, outcomes and resource use between salicylate poisoning patients with and without gastrointestinal bleeding.. Of 13 805 hospital admissions for salicylate poisoning, gastrointestinal bleeding occurred in 482 (3.5%) admissions. The risk factors for gastrointestinal bleeding included older age, history of atrial fibrillation and cirrhosis. After adjusting for difference in baseline characteristics, patients with gastrointestinal bleeding required more gastric lavage, gastrointestinal endoscopy, invasive mechanical ventilation and red blood cell transfusion. Gastrointestinal bleeding was significantly associated with increased risk of anemia, circulatory, liver and hematological failure but was not significantly associated with increased in-hospital mortality. The length of hospital stay and hospitalization cost was significantly higher in patients with gastrointestinal bleeding.. Gastrointestinal bleeding occurred in about 4% of patients admitted for salicylate poisoning. Gastrointestinal bleeding was associated with higher morbidity and resource use but not mortality.

Topics: Databases, Factual; Gastrointestinal Hemorrhage; Hospital Mortality; Hospitalization; Humans; Retrospective Studies; Salicylates; United States

We report the case of a 4-years-old boy who was admitted with hypovolemic shock due to a severe gastrointestinal bleeding. The esophagogastroduodenoscopy (EGDS) showed hiatus hernia, erosions and ulcerations of the lower esophagus, possibly due to a gastroesophageal reflux, and a small duodenal erosion. The child was previously healthy and he had never shown any symptoms related to this condition. The only product taken by the child in the previous days was a syrup containing several herbs, among which Filipendula ulmaria (L.) Maxim. and Salix spp. (known to contain salicylates), marketed as food and prescribed by his paediatrician to treat a mild cold accompanied by fever. Quali-quantitative analysis confirmed the presence of salicylates in the syrup. Naranjo algorithm showed a probable correlation between the onset of symptoms and the consumption of the herbal remedy. The child recovered after receiving intensive care. The product was withdrawn from Italian market.

Topics: Child, Preschool; Chromatography, High Pressure Liquid; Common Cold; Critical Care; Drug Recalls; Endoscopy, Digestive System; Gastrointestinal Hemorrhage; Hernia, Hiatal; Humans; Italy; Male; Plant Preparations; Reference Standards; Salicylates; Shock

Despite prescription of gastroprotection among elderly nonsteroidal anti-inflammatory drug (NSAID) users, residual bleeding can still occur. We sought to determine the effect of proton pump inhibitors (PPI) on hospitalization and resource use among veterans in whom an upper gastrointestinal event (UGIE) occurred.. We identified from national pharmacy records veterans > or =65 years prescribed an NSAID, cyclooxygenase-2 selective NSAID (coxib), or salicylate (>325 mg/day) at any Veterans Affairs (VA) facility (01/01/00-12/31/04). Prescription fill data were linked longitudinally to a Veterans Affairs-Medicare dataset of inpatient, outpatient, and death files, and demographic and provider data. Among veterans in whom a UGIE occurred, we assessed the effect of prescription strategy on hospitalization, using a multivariate logistic regression model.. A total of 3566 UGIEs occurred among a cohort that was predominantly male (97.5%), white (77%), with a mean age of 73.5 (SD, 5.7). Hospitalization occurred in 47.5%, and gastroprotection was associated with a 30% reduction in hospitalization compared with no PPI. Five-year pharmacy costs associated with the PPI strategy exceeded the no-PPI strategy ($742,406 vs $184,282); however, a substantial reduction in medical costs was observed with PPI ($9,948,738 vs $18,686,081).. Even if an NSAID-UGIE occurs in the PPI-protected older veteran, the reduction in need for hospitalization results in a cost saving to the Department of Veterans Affairs.

Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase 2 Inhibitors; Female; Gastrointestinal Hemorrhage; Health Care Costs; Hospitalization; Humans; Male; Proton Pump Inhibitors; Salicylates; Veterans

The gastric irritant properties of nonsteroidal anti-inflammatory drugs (NSAID) are well established but the pathogenic mechanisms by which these agents damage the mucosa or delay its repair are poorly understood. The phenomenon of gastric adaptation after repeated exposures to ASA is well documented but the involvement of Helicobacter pylori (H. pylori) in NSAID-induced gastropathy and adaptation has not been elucidated. The aim of this study was 1) to compare the gastric damage in response to repeated exposures to ASA in the same subjects before and after eradication of H. pylori and 2) to examine the morphological and functional changes of gastric mucosa during the 14 day treatment with ASA in H. pylori-infected subjects before and after eradication of this bacteria: Eight healthy volunteers (age 19-28) with H. pylori infection were given ASA 1g bd during 14 days before and after H. pylori eradication. Mucosal damage was evaluated by endoscopy before and at 3, 7 and 14 days of ASA administration using modified Lanza score. During endoscopy mucosal biopsies were obtained for determination of DNA synthesis, by measuring 3H-thymidine incorporation into DNA. Prior to each endoscopy gastric microbleeding was determined in three consecutive gastric washings. Three months after successful eradication of H. pylori confirmed by 13C-urea breath test and mucosal rapid urease test, the same subjects received again 14 day treatment with ASA and underwent the same examinations as prior to the therapy. In all subjects, ASA administration induced acute gastric damage with endoscopic Lanza score reaching maximum at 3rd day. In H. pylori-positive subjects, this damage was maintained at similar level up to day 14th, whereas in H. pylori-eradicated subjects, this damage was lessened at day 14th by about 60-75%. Gastric microbleeding also reached its maximum at 3rd day of ASA treatment being significantly higher in H. pylori-eradicated subjects than in those with H. pylori infection. This microbleeding decreased to almost normal values by the end of the study in all H. pylori-negative subjects but remained significantly elevated in H. pylori-infected subjects. DNA synthesis before and following ASA administration was significantly higher in subjects after H. pylori eradication than in those with H. pylori infection. Moreover, this DNA synthesis showed significant increase at day 7 of ASA administration only in H. pylori-eradicated subjects. We conclude that: 1) gastric ada

Topics: Adaptation, Physiological; Adult; Aspirin; DNA; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Salicylates

Gastrointestinal bleeding is related to non-steroidal anti-inflammatory drug (NSAID) use, especially aspirin, but only a small subset of users bleed.. To look for risk factors or mechanisms whereby aspirin may promote gastrointestinal bleeding.. Sixty one patients with previous aspirin related upper gastrointestinal bleeding and 61 matched controls.. Patients and controls were given 375 mg of aspirin and sequential skin bleeding time and blood aspirin levels were measured. Additional studies included platelet lumiaggregation, von Willebrand factor, Factor VIII, and coagulation studies.. Baseline skin bleeding time was similar in bleeders and controls, but bleeders had a more prolonged skin bleeding time after aspirin use. Hyper-response was more frequent in bleeders (30% v 9.3%; p < 0.01) and was associated with more than one previous separate bleeding event and a lower packed cell volume during the preceding bleeding episode. No differences were found in other factors studied. Logistic regression analysis identified prolonged skin bleeding time after aspirin use as an independent factor contributing to aspirin related gastrointestinal bleeding (RR = 5.4; 95% CI: 1.8 to 17.1).. 30% of patients with a history of aspirin related gastrointestinal bleeding have an exaggerated prolongation of skin bleeding time in response to aspirin, which may be a risk factor for bleeding. This intrinsic defect or to subclinical von Willebrand disease or different aspirin metabolism.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Bleeding Time; Blood Coagulation; Factor VIII; Female; Gastrointestinal Hemorrhage; Hematocrit; Humans; Male; Middle Aged; Regression Analysis; Risk Factors; Salicylates; Salicylic Acid; Smoking; von Willebrand Factor

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arginine; Aspirin; Detergents; Gastric Mucosa; Gastrointestinal Hemorrhage; Gels; Intestinal Mucosa; Mucus; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Phospholipids; Rats; Salicylates; Stomach Ulcer

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chromatography, High Pressure Liquid; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Salicylates; Spectrometry, Fluorescence; Surveys and Questionnaires

The adverse effect of topical methylsalicylate ointment on warfarin anticoagulation is studied in 11 patients. All patients had an abnormally elevated international normalized ratio after significant usage of topical methylsalicylate ointment as obvious from both the clinical history and a positive blood level of salicylate. Out of the 11 patients, 3 had bleeding manifestation; 2 with bruises and 1 with gastrointestinal bleeding. It is concluded that topical methylsalicylate ointment should be prescribed with care to patients on warfarin and excessive usage is to be avoided since potentially dangerous drug interaction could occur.

Topics: Administration, Topical; Adult; Aged; Blood Coagulation; Drug Synergism; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Ointments; Salicylates; Warfarin

Rats and mice were fed a diet containing aspirin at levels of 0, 0.3, 0.6 and 1.2% for 1 and 4 weeks. Haemorrhagic death and/or haemorrhagic anaemia occurred in rats in a dose-dependent manner. Prothrombin and kaolin-activated partial thromboplastin time indices were also decreased depending on the daily doses. However, no conspicuous haemorrhagic signs were found in mice given aspirin. These results suggest marked differences in haemorrhagic effects of aspirin between rats and mice. From results of supplementary experiments with two metabolites of aspirin, salicylic acid and gentisic acid, and from the fact of close relationship between hepatic concentration of salicylic acid and haemorrhagic effects of aspirin, it is inferred that salicylic acid may be a precursor for the active metabolite(s) to cause haemorrhage. The mechanism of species differences of aspirin is discussed.

Topics: Animals; Aspirin; Dose-Response Relationship, Drug; Gastrointestinal Hemorrhage; Gentisates; Hydroxybenzoates; Kaolin; Liver; Male; Mice; Mice, Inbred ICR; Organ Size; Partial Thromboplastin Time; Prothrombin Time; Rats; Rats, Inbred Strains; Salicylates; Salicylic Acid; Species Specificity; Time Factors

Gastrointestinal fecal blood loss, determined by injecting 51Cr-labelled autologous red blood cells, was measured in 191 orthopaedic patients after oral or parenteral intake of different forms of acetylsalicylates or salicylates. Oral or parenteral administration of non-acetylated salicylates caused nearly no gastrointestinal bleeding, but the anti-inflammatory activity of these products can be questioned since they cannot inhibit prostaglandin synthetase. Buffered, soluble forms of acetylsalicylates caused gastrointestinal bleeding in more than 50% of the patients. However, enteric-coated and intravenous forms resulted in significantly less gastrointestinal bleeding. For both preparations a relationship between serum salicylate level and amount of fecal blood loss was found in the group of "bleeders" (an upper limit of physiological blood loss could definitely be determined by this method). The findings suggested a similar mode of action of enteric-coated and intravenous acetylsalicylates on gastric mucosa through a systemic action. It was concluded that in long-term anti-inflammatory salicylate treatment, enteric-coated forms are probably the galenic form of first choice.

Topics: Administration, Oral; Aspirin; Dosage Forms; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Injections, Intravenous; Male; Occult Blood; Salicylates

We have examined the effects of seven different "barrier breakers" (including ethanol, aspirin, salicylic acid, isobutyric acid, Na taurocholate, thermal injury, and hyperosmotic glucose) on chambered gastric mucosae of rats in an attempt to identify variations in accepted indicators of mucosal barrier integrity which would accurately predict the extent of subsequent hemorrhagic erosion. When results from all experimental groups were considered, only the initial decrease in transmucosal potential difference (PD) showed significant correlation with final damage (lesion area). When the results were analyzed as separate subgroups, significant correlations were also found between net K+ efflux during the first 10 min after luminal infusion and final lesion area. Only in the subgroup containing ethanol, salicylates, and thermal injury was there a correlation between net loss of luminal H+ (back-diffusion) and lesion area. These results are considered in terms of their implications for the ulcerogenic actions of each group of agents.

Topics: Animals; Aspirin; Ethanol; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Mannitol; Prognosis; Rats; Rats, Inbred Strains; Salicylates; Salicylic Acid; Stomach Ulcer; Taurocholic Acid

Topics: Acute Disease; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents; Child; Ethanol; Gastrointestinal Hemorrhage; Humans; Middle Aged; Potassium; Salicylates

Topics: Anti-Inflammatory Agents; Arthritis; Aspirin; Central Nervous System Diseases; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Drug Interactions; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Kidney Diseases; Salicylates

Topics: Anti-Inflammatory Agents; Dinoprostone; Gastrointestinal Hemorrhage; Humans; Prostaglandins E; Rheumatic Diseases; Salicylates

Topics: Bismuth; Color; False Positive Reactions; Feces; Female; Gastrointestinal Hemorrhage; Heme; Humans; Infant; Organometallic Compounds; Salicylates

The relative risks associated with anti-inflammatory drug prescription for patients with an earlier history of drug-associated gastro-intestinal disturbance have been investigated in a retrospective study. Under these circumstances ibuprofen was well tolerated. The risks associated with modified salicylates (principally aspirin in enteric-coated form) and indomethacin suppositories also appeared to be relatively slight. Retreatment with phenylbutazone, oral indomethacin, naproxen and combination therapy was hazardous.

Topics: Administration, Oral; Aged; Anti-Inflammatory Agents; Arthritis; Duodenal Ulcer; Female; Gastrointestinal Hemorrhage; Humans; Ibuprofen; Indomethacin; Male; Middle Aged; Osteoarthritis; Peptic Ulcer; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Salicylates; Suppositories; Time Factors

Topics: Diflunisal; Gastrointestinal Hemorrhage; Humans; Platelet Aggregation; Risk; Salicylates

Topics: Animals; Aspirin; Bismuth; Feces; Gastrointestinal Hemorrhage; Male; Occult Blood; Organometallic Compounds; Rats; Salicylates

Topics: Aged; Diflunisal; Female; Gastrointestinal Hemorrhage; Humans; Middle Aged; Salicylates

The daily gastrointestinal blood loss caused by plain and microencapsulated acetylsalicylic acid (ASA) tablets was compared. Fourteen healthy, male volunteers participated in a double-blind, cross-over study, lasting 38 days. Before drug administration a median gastrointestinal bleeding of 0.9 ml/24 h was observed. During oral intake of 1.5 g ASA twice a day for 5 days, an increased faecal blood loss was seen in all volunteers. The increase was significant for both plain and microencapsulated ASA (p less than 0.01). Plain ASA tablets, however, caused a greater faecal blood loss than the microencapsulated tablets (p = 0.05), maximum median levels being 6.2 ml/24 h and 3.9 ml/24 h, respectively. An optimal design of radiochromium studies for determination of drug-induced gastrointestinal blood loss is discussed.

Topics: Adult; Aspirin; Chromium Radioisotopes; Double-Blind Method; Feces; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Salicylates; Time Factors

One hundred and eighty four patients aged over 65 years and hospitalised for gastrointestinal haemorrhage of high origin underwent emergency oesophago-gastro-duodenoscopy. It was thereby possible to make an aetiological diagnosis in 94.5% of cases. The study demonstrated certain special features: the preponderance of acute gastro-duodenal lesions, possibly explained by the high consumption of gastrotoxic drugs in the elderly subject; the relative frequency of oesophagitis (11%), one out of two cases being responsible for the bleeding; the discovery of a hiatal hernia in 59 patients (1/3 of cases), 25% of them bleeding from a lesion directly related to the latter. Bleeding was in large quantity in 57% of cases. Mortality, which was quite high (17%) appeared to be more related to the underlying general condition than to the haemorrhage itself. Endoscopy gave rise to complications in 8 patients, including 3 who died.

Topics: Aged; Anti-Inflammatory Agents; Duodenum; Endoscopy; Esophageal Diseases; Esophagitis; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hematemesis; Hernia, Hiatal; Humans; Male; Melena; Peptic Ulcer Hemorrhage; Salicylates

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

The gastrointestinal blood loss caused by the two antirheumatic drugs acetyl salicylic acid (ASA) and 4-acetamidophenyl-2-acetoxybenzoate (benorilate, Benortan) was compared in experimental animals and humans by measuring the total body iron retention. In Wistar rats and humans the results indicate that the daily iron loss under ASA is significantly higher (almost by the factor 2) than that under benorilate.

Topics: Animals; Aspirin; Gastrointestinal Hemorrhage; Humans; Iron; Iron Radioisotopes; Male; Rats; Salicylates; Time Factors

Topics: Animals; Aspirin; Bismuth; Cold Temperature; Condiments; Ethanol; Female; Gastrointestinal Hemorrhage; Male; Rats; Restraint, Physical; Salicylates; Time Factors

Topics: Adult; Aged; Cortisone; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Peptic Ulcer Hemorrhage; Phenylbutazone; Renal Dialysis; Salicylates; Sepsis

We have made a series of 4- and 5-aryl- and 4- and 5-heteroarylsalicylic acid derivatives with the objective of reducing gastric irritation and increasing potency. Here we describe a series of 4- and 5-heterocyclic salicylic acids and their antiinflammatory-analgesic potencies measured in comparison to aspirin. An improvement of the therapeutic index over aspirin of 100 was achieved; however, the heterocyclic salicylic acids lacked antipyretic activity. Some physicochemical parameters which may bear on the antiinflammatory activity of these compounds are discussed.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Chemical Phenomena; Chemistry, Physical; Dogs; Edema; Gastrointestinal Hemorrhage; Rats; Salicylates

Topics: Adrenal Cortex Hormones; Duodenal Ulcer; Gastrointestinal Hemorrhage; Hematemesis; Humans; Mallory-Weiss Syndrome; Melena; Middle Aged; Pancreatic Diseases; Peptic Ulcer Hemorrhage; Prognosis; Salicylates; Shock, Hemorrhagic; Stomach Ulcer

Topics: Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Experimental; Dogs; Edema; Female; Fluorobenzenes; Gastrointestinal Hemorrhage; Humans; In Vitro Techniques; Lethal Dose 50; Male; Mice; Peptic Ulcer; Platelet Aggregation; Rabbits; Rats; Salicylates; Time Factors

A multifactorial basis has been shown to exist in the development of gastric damage induced by aspirin and related N.S.A.I. drugs. Aspirin-induced gastric damage is characterized by a variety of physical and biochemical changes induced in the gastric mucosa which occur at different stages after administration of the drug. Aspirin only causes gastric ulceration and massive haemorrhage in the stomach when the stomach has been sensitized by the prior exposure to moderate stress conditions (which may resemble anxiety or psychologic stress). A model of ulcer development in which aspirin or other N.S.A.I. drugs are given to rats or pigs exposed to brief periods of stress has been described. Using this more sensitive assay procedures can be explored for reducing the gastric damaging effects of N.S.A.I. drugs. One such procedure involves chemical modification of the carboxylic acid moiety of aspirin.

Topics: Animals; Aspirin; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Guinea Pigs; Humans; Pregnancy; Prostaglandins E; Rats; Salicylates; Stomach; Stomach Ulcer; Stress, Psychological; Structure-Activity Relationship; Swine

Complex formation between salicylic acid and adenosine or adenosine triphosphate in 0.2m phosphate buffer at pH=7 was investigated as a potential factor contributing to the prolongation of acetylsalicylic acid-induced GI blood loss. Spectrophotemetric techniques were used to evalute the complexation. Concerntration dependency of the absorbance decrease was measured at 27 and 37 degrees C. The addition of salicylic acid to either adenosine or adenosine triphosplate solutions appeared also to cause a decrease in surface tension which may play a role in reducing platelet aggregation induced by adenosine diphosphate. The results obtained seem to support the opinion that the mechansim of acetylsalicylic acid-induced GI blood loss is due to a combination of both local and systemic effect.

Topics: Adenosine; Adenosine Triphosphate; Aspirin; Chemical Phenomena; Chemistry; Gastrointestinal Hemorrhage; Hydrogen-Ion Concentration; Salicylates; Surface Tension

A boy, 2 years old, developed a HUS after a pneumonitis. He was treated with Heparin, salicylates and recurrent peritoneal dialysis and recovered slowly. The course of the disease was complicated by myocarditis, gastric hemorrhage and severe neurologic disturbances. 7 days after unset of hemolysis a cold agglutinin titer of 1:256 was detected. This fact arises the question whether infection with Mycoplasma pneumoniae and the presence of cold agglutinins in serum could be involved in the development of HUS. The possibility of a viral etiology for this disease is discussed.

Topics: Agglutinins; Child, Preschool; Cold Temperature; Gastrointestinal Hemorrhage; Hemolysis; Hemolytic-Uremic Syndrome; Heparin; Humans; Lung Diseases; Male; Mycoplasma Infections; Myocarditis; Nervous System Diseases; Peritoneal Dialysis; Salicylates

Topics: Acute Disease; Adolescent; Adult; Aged; Aspirin; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Male; Melena; Middle Aged; Salicylates

Topics: Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Salicylates

Topics: Antacids; Aspirin; Buffers; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Intestinal Absorption; Salicylates; Solubility; Solutions

Salicylate-induced gastric erosions have been shown to disappear despite continuing salicylic acid administration in the rat. On the other hand, numerous drugs are able to change the capacity of the gastric mucosa to conjugate xenobiotics, which gives reason to follow gastric resistance to salicylic acid and to correlate it with changes in mucosal rate of drug biotransformation reactions. Gastric and duodenal UDP glucuronyltransferase activity decreased markedly within 12 hours after a single dose of salicylic acid. when continuing salicylic acid administration, macroscopic gastric lesions disappeared within 3 days and mucosal UDP glucuronyltransferase activity increased above control level. In 2 weeks the activity returned to control level. In spite of the fact that salicylates markedly inhibited gastroduodenal glucuronidation in vitro, there was no substrate effect of salicylic acid present at the time rats were killed. Duodenal 3,4-benzpyrene hydroxylase activity was not affected by salicylic acid administration. The gastric activity of benzpyrene hydroxylase in controls and in rats treated with salicylic acid was below the sensitivity of the method. Hepatic detoxification capacity was quite stable. A slight depression of 3,4-benzpyrene hydroxylase activity did, however, take place within 2 weeks. Gastric and duodenal protein contents decreased after a single salicylic acid administration, but returned to control level in 5 days in the duodenum, and in 2 weeks in the stomach, when the administration was prolonged. The results suggest that mucosal detoxification capacity may have a role in the pathogenesis of drug-induced gastric erosions. Gastric mucosa adapts to repeated salicylic acid administration, having reduced susceptibility to drug-induced erosions.

Topics: Animals; Biotransformation; Duodenum; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Glucuronosyltransferase; Intestinal Mucosa; Liver; Male; Microsomes, Liver; Mixed Function Oxygenases; Proteins; Rats; Salicylates; Sodium Salicylate; Stomach Diseases

Topics: Gastric Mucosa; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Salicylates

Four hundred consecutive patients, in a representative Southern California population, hospitalized for upper gastrointestinal hemorrhage, had endoscopic examinations performed within 24 hours of arrival in the emergency room. Seventy-four (18.5 percent) of these were found to have the typical lesions of acute hemorrhagic erosive gastritis. The clinical spectrum of this group is examined and a comparison made with a Veterans Hospital population reported previously.

Topics: Adult; Aged; Duodenal Ulcer; Esophageal and Gastric Varices; Esophagitis; Ethanol; Female; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Salicylates; Sex Ratio; Stomach Ulcer

Topics: Acute Disease; Adult; Female; Gastroenterostomy; Gastrointestinal Hemorrhage; Humans; Influenza, Human; Peptic Ulcer Hemorrhage; Postoperative Complications; Salicylates

A total of 125 patients with rheumatoid arthritis were investigated about their drug therapy before referral to a specialist centre. Most referrals were from general practitioners. Only 47 of the patients had received salicylates as the first drug and 18 had never had them at all. Soluble aspirin was the preparation of salicylates most frequently prescribed (for 63 patients). Only 60 patients had been given an adequate dose and only 62 an adequate course of treatment with salicylates. In 28 patients salicylates had been stopped on account of side effects. About one-third of the patients had been prescribed oral corticosteroids.The referral letters were poor in giving details of past and present drug therapy, and there were serious omissions in reporting of previous side effects.Seventy-five general practitioners were asked to rate several currently marketed antirheumatic drugs in terms of effectiveness. Though prednisolone 15 mg daily ranked higher than aspirin 4 g daily the difference was not significant. The study shows the inadequacies of drug prescribing for rheumatoid arthritis in the Glasgow area.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Arthritis, Rheumatoid; Aspirin; Drug Prescriptions; Dyspepsia; Family Practice; Female; Gastrointestinal Hemorrhage; Humans; Indomethacin; Male; Middle Aged; Phenylbutazone; Prednisone; Salicylates; Scotland

Topics: Acetanilides; Adult; Aged; Anti-Inflammatory Agents; Aspirin; Blood Transfusion; Female; Gastritis; Gastrointestinal Hemorrhage; Hematemesis; Humans; Male; Melena; Methyl Ethers; Middle Aged; Naphthalenes; Propionates; Salicylates

Topics: Analgesics; Anti-Inflammatory Agents; Antimalarials; Aspirin; Digestive System; Duodenal Ulcer; Esophagoscopy; Gastritis; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Gastroscopy; Glycols; Humans; Indomethacin; ortho-Aminobenzoates; Phenylbutazone; Pyrazoles; Quinolines; Salicylates; Stomach Ulcer

Topics: Adenosine Diphosphate; Blood Coagulation Disorders; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Infant, Newborn; Maternal-Fetal Exchange; Platelet Adhesiveness; Pregnancy; Salicylates; Vitamin K

Topics: Adenosine; Adenosine Triphosphate; Aspirin; Chemical Phenomena; Chemistry; Drug Interactions; Gastrointestinal Hemorrhage; Hydrogen-Ion Concentration; Kinetics; Platelet Aggregation; Salicylates; Spectrophotometry, Ultraviolet

Topics: Animals; Aspirin; Benzidines; Drug Combinations; Drug Hypersensitivity; Feces; Gastrointestinal Hemorrhage; Guaiac; Guinea Pigs; Lithium; Mice; Occult Blood; Quinine; Rabbits; Rats; Salicylates

Topics: Acute Disease; Adult; Anticoagulants; Cortisone; Diagnostic Errors; Drug Synergism; Emergencies; Esophageal and Gastric Varices; Esophagitis; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Peptic Ulcer Hemorrhage; Retrospective Studies; Salicylates

Topics: Alcoholic Beverages; Anticoagulants; Blood Transfusion; Cortisone; Drug Therapy, Combination; Gastrointestinal Hemorrhage; Hip Joint; Humans; Indomethacin; Joint Diseases; Kidney Diseases; Liver Cirrhosis; Neoplasms; Phenylbutazone; Postoperative Complications; Prospective Studies; Salicylates; Stomach Diseases

Topics: Adult; Age Factors; Aged; California; Esophageal and Gastric Varices; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Hematemesis; Hematocrit; Hospitalization; Humans; Liver Cirrhosis; Melena; Middle Aged; Peptic Ulcer; Recurrence; Salicylates; Shock, Hemorrhagic

Topics: Alcohol Drinking; Barium Sulfate; Diagnosis, Differential; Esophageal and Gastric Varices; Esophagoscopy; Ethanol; Fiber Optic Technology; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Mallory-Weiss Syndrome; Peptic Ulcer; Radiography; Salicylates; Time Factors

Topics: Administration, Oral; Adult; Aspirin; Chromium Radioisotopes; Drug Tolerance; Female; Gastrointestinal Hemorrhage; Humans; Male; Occult Blood; Salicylates; Time Factors

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Aged; Cathartics; Chemical and Drug Induced Liver Injury; Cholestasis; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Iatrogenic Disease; Indomethacin; Insecticides; Pancreatitis; Peptic Ulcer; Phenylbutazone; Potassium Chloride; Reserpine; Salicylates; Thiazines

Topics: Animals; Arthritis, Rheumatoid; Aspirin; Diatrizoate; Gastrointestinal Hemorrhage; Humans; Platelet Adhesiveness; Rats; Salicylates; Sorbitol

Topics: Administration, Oral; Animals; Aspirin; Autopsy; Autoradiography; Biopsy; Body Weight; Dogs; Epithelial Cells; Gastric Mucosa; Gastrointestinal Hemorrhage; Histocytochemistry; Mucins; Salicylates; Stomach; Stomach Ulcer; Time Factors

Topics: Adolescent; Anemia, Hypochromic; Barium Sulfate; Blood Transfusion; Gastrointestinal Hemorrhage; Humans; Leiomyoma; Male; Melena; Occult Blood; Salicylates; Stomach Neoplasms

Topics: Adrenal Cortex Hormones; Analgesics; Antibodies; Anticoagulants; Antihypertensive Agents; Antineoplastic Agents; Antitubercular Agents; Cathartics; Diuretics; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Hemorrhage; Humans; Salicylates

Topics: Acute Disease; Adolescent; Adult; Aged; Colitis, Ulcerative; Ethanol; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Salicylates; Stress, Physiological

Topics: Gastrointestinal Hemorrhage; Humans; Salicylates

Topics: Adult; Aged; Aspirin; Chromium Isotopes; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Occult Blood; Rheumatic Diseases; Salicylates

Topics: Gastrointestinal Hemorrhage; Humans; Salicylates; Stomach Diseases

Topics: Acetates; Administration, Oral; Animals; Aspirin; Benzoates; Carboxylic Acids; Epithelium; Female; Gastric Mucosa; Gastrointestinal Hemorrhage; Hydrochloric Acid; Male; Mice; Microscopy, Electron; Salicylamides; Salicylates

Topics: Anti-Inflammatory Agents; Aspirin; Choline; Chromium Isotopes; Erythrocytes; Feces; Gastrointestinal Hemorrhage; Humans; Mass Screening; Outpatient Clinics, Hospital; Salicylates

Topics: Adult; Analgesics; Anti-Inflammatory Agents; Aspirin; Fever; Gastrointestinal Hemorrhage; Humans; Intestinal Absorption; Kidney Diseases; Salicylates; Uricosuric Agents

Topics: Abnormalities, Drug-Induced; Animals; Chemical and Drug Induced Liver Injury; Female; Fetal Death; Fetal Diseases; Gastrointestinal Hemorrhage; Gestational Age; Hemorrhage; Injections, Intramuscular; Liver; Mice; Pentobarbital; Pregnancy; Salicylates

Topics: Acid-Base Equilibrium; Child; Gastric Lavage; Gastrointestinal Hemorrhage; Humans; Hypotonic Solutions; Poisoning; Salicylates; Vomiting

Topics: Adrenochrome; Aged; Female; Gastrointestinal Hemorrhage; Hematocrit; Hemostatics; Humans; Male; Middle Aged; Salicylates; Semicarbazides

Topics: Adrenal Cortex Hormones; Anemia; Barbiturates; Bone Marrow; Chloramphenicol; Chlorpromazine; Dihydroxyphenylalanine; Gastrointestinal Hemorrhage; Gold; Humans; Hypoglycemic Agents; Indomethacin; Isoniazid; Nitrofurantoin; Phenacetin; Phenylbutazone; Phenytoin; Quinidine; Quinine; Salicylates; Sulfonamides

Topics: Adrenal Cortex Hormones; Aged; Anti-Inflammatory Agents; Duodenal Ulcer; Female; Gastrointestinal Hemorrhage; Humans; Indomethacin; Male; Middle Aged; Nicotinic Acids; Peptic Ulcer Hemorrhage; Phenylbutazone; Salicylates

Topics: Animals; Electrolytes; Gastric Dilatation; Gastric Mucosa; Gastrointestinal Hemorrhage; Models, Biological; Pressure; Rabbits; Salicylates; Stomach

Studies of the effect of intravenous sodium acetylsalicylate (aspirin) on gastrointestinal blood loss with (51)Cr-labelled red cells were made on 15 healthy male volunteers. After a control period of five days 1 g. of sodium acetylsalicylate was infused over a period of 100 minutes twice daily for three days. Faecal blood loss was not increased.In a further six subjects 3 g. of sodium acetylsalicylate was infused over a period of 120 minutes. No salicylate or acetylsalicylate was detected in saliva or gastric washings from these six subjects. Hence gastrointestinal blood loss induced by aspirin may be explained by a local effect on mucosa and not by any systemic effect.

Topics: Adult; Aspirin; Chromium Isotopes; Erythrocytes; Feces; Gastric Juice; Gastrointestinal Hemorrhage; Humans; Injections, Intravenous; Male; Occult Blood; Salicylates; Saliva

Topics: ABO Blood-Group System; Adult; Aspirin; Blood Group Antigens; Chromium Isotopes; Erythrocytes; Feces; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Occult Blood; Prothrombin; Salicylates

Topics: Chronic Disease; Diverticulum; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Genetic Diseases, Inborn; Hematologic Diseases; Hernia, Diaphragmatic; Hookworm Infections; Humans; Hysteria; Occult Blood; Salicylates

Topics: Adult; Anemia; Cholesterol; Female; Gastrointestinal Hemorrhage; Humans; Hypercholesterolemia; Salicylates; Tendons; Xanthomatosis

Topics: Adolescent; Biopsy; Child; Child, Preschool; Diet Therapy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gold Isotopes; Humans; Hypertension, Portal; Infant; Liver; Liver Circulation; Male; Mercury Isotopes; Portography; Pregnancy; Pregnancy Complications, Hematologic; Radionuclide Imaging; Salicylates

Topics: Adult; Aged; Aspirin; Feces; Female; Gastrointestinal Hemorrhage; Humans; Male; Melena; Middle Aged; Salicylates

Topics: Adult; Chromium Isotopes; Erythrocytes; Feces; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Salicylates

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Anticoagulants; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Postoperative Complications; Salicylates

Topics: Animals; Aspirin; Chromium Isotopes; Dogs; Gastric Mucosa; Gastrointestinal Hemorrhage; Salicylates

Topics: Absorption; Animals; Aspirin; Bethanechol Compounds; Denervation; Dogs; Gastric Mucosa; Gastrins; Gastrointestinal Hemorrhage; Hemorrhage; Histamine; Intestinal Absorption; Ion Exchange; Pharmacology; Research; Salicylates; Salicylic Acid; Sympathomimetics; Toxicology

Topics: Chromium Isotopes; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Salicylates

Topics: Abdomen; Abdomen, Acute; Adrenal Cortex Hormones; Colchicine; Gastrointestinal Hemorrhage; Gout; Kidney Diseases; Phenylbutazone; Salicylates; Shock; Toxicology; Uricosuric Agents; Zoxazolamine

Topics: Aspirin; Digestion; Gastrointestinal Hemorrhage; Hemorrhage; Salicylates; Toxicology

Topics: Cardiac Surgical Procedures; Gastrointestinal Hemorrhage; Hemorrhage; Mitral Valve Stenosis; Postoperative Complications; Salicylates; Thoracic Surgery; Toxicology

Topics: Aspirin; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Aspirin; Gastritis; Gastrointestinal Hemorrhage; Humans; Salicylates

Topics: Administration, Intravenous; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Adrenal Cortex Hormones; Analgesics; Analgesics, Non-Narcotic; Antipyretics; Gastrointestinal Hemorrhage; Salicylates

Topics: Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Hemorrhage; Humans; Hydrochloric Acid; Salicylates

Topics: Digestion; Gastric Juice; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Humans; Salicylates

Topics: Anemia; Anemia, Hypochromic; Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hematologic Diseases; Hemorrhage; Humans; Salicylates

Topics: Aspirin; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates; Stomach; Stomach Diseases

Topics: Aspirin; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Salicylates; Stomach; Stomach Diseases

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Humans; Salicylates

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Tract; Hemorrhage; Humans; Salicylates; Stomach Diseases