Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, Japan.
Digestion. 2012;85(1):9-17. doi: 10.1159/000329295. Epub 2011 Nov 24.
Aspirin enjoys widespread use as an antithrombotic drug, but such ubiquity also increases the risk of gastrointestinal mucosal injury. Recent studies have shown that aspirin can also induce esophageal mucosal injury. We resolved to determine the intragastric pH value necessary to prevent aspirin-induced esophageal mucosal injury.
15 healthy Japanese volunteers were dosed for 7 days in a four-way random crossover trial with 100 mg entero-coated type aspirin only once daily, 100 mg aspirin + 20 mg famotidine twice daily, 15 mg lansoprazole once daily, or 10 mg rabeprazole once daily. All subjects underwent endoscopy and intragastric pH monitoring on day 7.
7 individuals (46.7%) developed esophageal mucosal injury when ingesting aspirin alone. The incidence of esophageal mucosal injury was reduced however with concomitant dosing of aspirin and famotidine (26.6%; p = 0.193), lansoprazole (0%; p = 0.004), and rabeprazole (6.7%; p = 0.019). Among individuals for whom mean 24-h pH was >5.0 and who experienced pH <4.0 less than 40% of the time, none developed aspirin-induced esophageal mucosal injury.
Acid inhibition achieved with a half-dose of a proton pump inhibitor effectively prevented development of aspirin-induced esophageal mucosal injury, whereas a standard dose of a histamine-2-receptor antagonist failed to achieve the same results.
阿司匹林作为一种抗血栓药物被广泛应用，但这种广泛应用也增加了胃肠道黏膜损伤的风险。最近的研究表明，阿司匹林也可诱导食管黏膜损伤。我们旨在确定预防阿司匹林诱导的食管黏膜损伤所需的胃内 pH 值。
15 名健康的日本志愿者参加了一项四向随机交叉试验，连续 7 天每天一次给予 100mg 肠溶型阿司匹林、100mg 阿司匹林+20mg 法莫替丁两次、15mg 兰索拉唑一次或 10mg 雷贝拉唑一次。所有受试者在第 7 天进行内镜检查和胃内 pH 监测。
单独服用阿司匹林时，有 7 名受试者（46.7%）发生食管黏膜损伤。然而，与阿司匹林和法莫替丁（26.6%；p=0.193）、兰索拉唑（0%；p=0.004）和雷贝拉唑（6.7%；p=0.019）同时给药可降低食管黏膜损伤的发生率。在平均 24 小时 pH 值>5.0 且 pH 值<4.0 的时间少于 40%的受试者中，均未发生阿司匹林诱导的食管黏膜损伤。
半剂量质子泵抑制剂的抑酸作用可有效预防阿司匹林诱导的食管黏膜损伤，而标准剂量的组胺 2 受体拮抗剂则未能达到相同的效果。
