Investigation of gastric and duodenal mucosal defects caused by low-dose aspirin in patients with ischemic heart disease.

BACKGROUND

Low-dose aspirin is used for secondary prevention of ischemic heart disease and ischemic cerebrovascular disease. Currently, the frequency of gastrointestinal disorder among users of low-dose aspirin is unknown.

AIMS

To investigate through endoscopic examination the frequency of gastroduodenal disorder associated with buffered and enteric-coated aspirin (ECA).

METHODS

Screening upper endoscopic examinations were prospectively performed on 236 patients with ischemic heart disease. Endoscopic findings including ulcers and flat erosions were assessed as mucosal defects.

RESULTS

Mucosal defects were found in 92 of 190 (48.4%) users of low-dose aspirin and 6 of 46 (13.0%) nonusers. There were significantly more mucosal defects among users of low-dose aspirin than among those using no aspirin (P<0.0001). Mucosal defects were found in 54 of 98 (60.7%) users of buffered aspirin (BA), whereas 38 of 101 (37.6%) users of ECA had mucosal defects. Users of ECA had significantly fewer erosions than did those of BA (P=0.0015). The frequency of ulcer is similar between BA users and ECA users.

CONCLUSIONS

As endoscopy frequently reveals gastroduodenal disorder among low-dose aspirin users, both administration of BA and of enteric-coated aspirin warrant concern for gastroduodenal ulcer.