Reduction in gastric mucosal hemorrhage and ulceration with chronic high-level dosing of enteric-coated aspirin granules two and four times a day

Abstract

When administered on a chronic high-dosage regimen, enteric-coated aspirin granules produced significantly less gastric damage than plain aspirin or aspirin-antacid combinations. Clinically meaningful damage occurred in all subjects receiving plain aspirin, 93% of those receiving aspirin-antacid combination and only 27% and 20% of those receiving enteric-coated aspirin granules qid and bid, respectively. All three aspirin formulations were taken as 1 g qid (4 g/day) and an additional group received enteric granules administered as 2 g bid (4 g/day). Gastric damage was assessed by means of endoscopy carried out after seven days of treatment. Enteric granules are equally safe when administered on a bid or qid regimen (at same total daily dosage) and, in a bid regimen, should provide a compliance advantage for patients on high-dose therapy for diseases such as rheumatoid arthritis.

Impact of Enteric vs Non-Enteric Coated Aspirin Preparations on Efficacy and Toxicity

“…Several endoscopic studies 6–10 comparing gastric and duodenal erosions between the different aspirin preparations have demonstrated significantly less mucosal damage with enteric-coated products, illustrating the local “contact” mechanism of aspirin induced gastric damage. However, it is known that these lesions are not good predictors of major upper GI bleeding.…”

“…However, it is known that these lesions are not good predictors of major upper GI bleeding. 11 These studies 6–10 have several limitations. Most of the studies were single-blind, of short duration (1 to 2 wk), used larger doses than our normal “preventative” dosing regimens, and recruited young, healthy volunteers.…”

Risk of Gastric Injury with Enteric- versus Nonenteric-Coated Aspirin

“…Injury to the duodenal mucosa was comparable in all groups. 6 Lanza et al 9 conducted a randomized, single-blind (to endoscopist) study evaluating the effects of gastric mucosal hemorrhage and ulceration with high-dose aspirin preparations. Fifty volunteers aged 21-45 years without a history of gastric or duodenal submucosal hemorrhage, erosions, or ulcer participated.…”

Controversies in the Detection and Management of Nonsteroidal Antiinflammatory Drug‐induced Side Effects of the Upper Gastrointestinal Tract

“…The type of NSAID might also be switched. e.g.• from uncoated to entericcoated ASA tablets (31), or from ASA or indomethacin (generally considered the most troublesome (10)) to a non-aspirin NSA'ID, or from one non-aspirin NSAID to another. Unfortunately.…”