Part I of II: IS IT SAFE TO TAKE ENTERIC COATED ASPIRIN?

Even low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage.

The small bowel was shown to be damaged by low-dose ASA even on a short-term basis in twenty healthy volunteers (age range, 19-64 years) who underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days.

Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.

Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05).

CONCLUSIONS: The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.

E. Smecuol Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment. Clin Gastroenterol Hepatol 7(5):524-9 (2009)

COMMENT:

The efforts to generate safer NSAIDS and aspirins includes enteric coated and slow release formulations. But these “safer” formulations simply shift the damage of these agents to a more distal site in the intestinal tract.

This study documents that even in the short term and in healthy controls a short course of enteric coated ASA can damage the small intestinal mucosa.

Half of the healthy study population showed mucosal damage.
This study must be taken into consideration by patients and their providers.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for PART II of II SHOULD EVERYONE TAKE ASA?

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