Question Title: Daily Aspirin Therapy

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Stomach Conditions

Is their a significant risk of damaging the stomach or any other part of the GI tract using this much aspirin daily?

Dear Jim,

Aspirin is a type of non-steroidal anti-inflammatory drug. It works by inhibiting an enzyme called cyclooxygenase, which is important in the formation of prostaglandins. Prostaglandins can have different effects throughout the body. In the stomach prostaglandins help decrease acid production and help to increase the mucous protective barrier so that stomach cells are not damaged by acid.

Non-steroidal anti-inflammatory drugs can cause acute, superficial injury with bleeding, erosions and shallow ulcers or deep ulcers with complications (bleeding or perforation) with chronic use. Injury to the stomach and small intestine from this class of medication occurs by a topical effect (by its contact with the stomach) and a systemic effect (by its absorption into the bloodstream).

Several factors appear to increase the risks of ulcers and their complications secondary to non-steroidal anti-inflammatory drugs. Persons older than 60 years of age, previous history of peptic ulcer disease or its complications, concomitant use of medications such as oral anticoagulants (coumadin) or corticosteroids (prednisone) with non-steroidal anti-inflammatory drugs and the increased dose of non-steroidal anti-inflammatory drugs. In patients who are at high risk for the development of complications from non-steroidal anti-inflammatory drugs and who cannot discontinue the drug should be strongly considered for prophylaxis with medications such as misoprostol (Cytotec) or omeperazole (Prilosec).

In terms of the question of whether a small dose of aspirin can cause injury to the stomach the answer is probably yes, however, the real question is if it is clinically relevant. The exact dose that is safe to use without any complications has not been determined. Several studies in patients taking long term aspirin for the prevention of myocardial infarction or stroke have shown that even in patients who had no history of bleeding or recent ulcer the risk of duodenal and gastric ulcers with bleeding is significantly increased. The dosages in these studies were 500 mg twice daily in one study and 325 mg every other day in another study. Thus, although the risk of non-steroidal anti-inflammatory drug injury may be dose-related, even one aspirin (adult) every other day can lead to ulcer formation. I hope you find this information helpful.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.

HFHSM.D.-ym
*Keywords: non-steroidal anti-inflammatory drugs, aspirin, gastroduodenal injury, risk factors, dose-related injury

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