Omeprazole ameliorates aspirin-induced gastroduodenal injury

Abstract

Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) damage the gastroduodenal epithelium by two mechanisms: direct toxic effects and effects related to the depletion of endogenous prostaglandins. The prostaglandin-depleted mucosa has increased susceptibility to luminal aggressive factors, yet the role of acid in the pathogenesis of the NSAID ulcer is controversial. In humans, standard doses of H2-receptor antagonists prevent only duodenal injury and provide no protection for the gastric mucosa. It is not known whether more potent suppression of acid can prevent NSAID damage. Twenty healthy volunteers were randomized to a double-blind, placebo-controlled, crossover study to determine if omeprazole, 40 mg/day prevents gastroduodenal injury due to two weeks of aspirin administration (650 mg four times a day). The severity of mucosal injury was quantitated by endoscopy and stratified by a scale from 0 (normal) to 4 (ulcer). Fourteen of the 20 subjects had less gastric injury during cotherapy with omeprazole. All six with no difference received aspirin plus omeprazole in the first treatment period. Omeprazole significantly decreased aspirin-induced gastric mucosal injury (P < 0.001, Wilcoxon signed-rank test). Omeprazole protected 85% of subjects from extensive gastric erosions (often associated with evidence of intraluminal bleeding) or ulceration, whereas 70% of the subjects developed aspirin-induced grades 3 and 4 gastric injury on placebo (P < 0.01 by chi 2). No subject taking omeprazole developed duodenal injury of any grade, while 50% taking placebo developed erosions and 15% had ulcer (P < 0.001). Medication side effects were mild in the majority of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvant Aspirin Therapy Reduces Symptoms of Schizophrenia Spectrum Disorders

“…At least 2 randomized, controlled trials have demonstrated that mucosal gastric injury from aspirin at similar or higher doses than those used in our study can be abolished by adjuvant use of the proton pump inhibitor omeprazole. 40,41 We therefore take the position that the gastrointestinal bleeding risk of high-dose aspirin is acceptable, provided that a proton pump inhibitor is additionally prescribed. This was supported by the fact that no serious gastric or bleeding events requiring medical attention were observed in our trial.…”

A guideline for the treatment and prevention of nsaid-induced ulcers

“…Omeprazole significantly decreased aspirin-induced gastric mucosal injury (p Ͻ 0.01) by protecting 85% of the subjects from extensive erosions or ulcer, whereas 70% of the subjects developed severe injury (rate 3 or 4 on 0 -4 scale) on aspirin and placebo. No duodenal injury was seen in any grade or any subject on omeprazole, whereas 50% on placebo developed erosions and 15% had DU (p Ͻ 0.001) (65).…”

Primary Prevention of Adverse Gastroduodenal Effects from Short-Term Use of Non-Steroidal Anti-Inflammatory Drugs by Omeprazole 20 mg in Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled Study

“…These results extend the results of other, smaller and/or non-controlled studies of primary prevention by PPIs of short-term non-selective NSAID-related GI side effects [31]. Most such studies have utilized aspirin (ASA) [32][33][34][35][36][37][38][39]. The available evidence suggests that OMP results in an approximately 75% decrease in the incidence of endoscopic lesions related to either low-dose or antiinflammatory dose of ASA daily [32,37].…”

“…Most such studies have utilized aspirin (ASA) [32][33][34][35][36][37][38][39]. The available evidence suggests that OMP results in an approximately 75% decrease in the incidence of endoscopic lesions related to either low-dose or antiinflammatory dose of ASA daily [32,37]. In one short-term study of primary prevention of NPX-related injury, OMP 40 mg daily, begun 48 h before starting NPX, resulted in approximately 40% reduction of gastric injury in 15 young, healthy volunteers [35].…”