Aspirin gastric ulcer

Prevention of gastric ulcers caused by aspirin or NSAID use (unlabeled use)... 

Bismudi subsalicylate is used in combination witii otiier dru > to treat gastric and duodenal ulcers caused by H. pylori bacteria Mesalamine is used in the treatment of chronic inflammatoiy bowel disease Misoprostol is used to prevent gastric ulcers in those taking aspirin or nonsteroidal anti-inflammatory dragp in high doses for a prolonged time Olsalazine is used in the treatment of ulcerative colitis in those allergic to sulfasalazine. Sulfasalazine is used in the treatment of Crohn s disease and ulcerative colitis. Sucralfate is used in the treatment of duodenal ulcer. 

Quite recently, a series of arylacetic acid derivatives has come into clinical use as potent antiinflammatory agents. In general, these compounds show profiles of activity quite similar to aspirin, and though as a rule they are more active and are less likely to cause or exacerbate gastric ulcers. 

Gl effects Use caution in those intolerant to salicylate because of Gl irritation, and in gastric ulcers, peptic ulcer, mild diabetes, gout, erosive gastritis, or bleeding tendencies. Salsalate and choline salicylate may cause less Gl irritation than aspirin. 

Acetaminophen is similar to salicylates in that it is a useful analgesic for mild to moderate pain, with equal efficacy to aspirin, and like aspirin, it is antipyretic. However, acetaminophen exerts little if any effects on platelet aggregation and is not antiinflammatory. Thus, it is not useful for patients with arthritis or other inflammatory diseases. It is also not useful as an antithrombotic agent in the prevention of myocardial infarction or transient ischemic attacks. Acetaminophen does not produce the gastric ulceration that can occur with aspirin and is useful in patients who are salicylate sensitive or who have a history of ulcers or other gastric ulcerations. 

Antiulcerogenic activity. Colloidal solution, administered orally to rats at a dose of 50 mg/kg, 60 minutes before experiment, produced significant protection against gastric ulcers induced by 2 hours cold restraint stress, aspirin, and 4 hours pylorus ligation " . ... 

Anti-ulcer activity. Water extract of the dried leaf, administered intragastrically to mice, was active against aspirin-induced gastric ulcers . 

Other activities on the gastrointestinal system included antidiarrhoeal and gastroprotective effects. Satureja hortensis and Aloysia triphylla EOs inhibited castor oil induced diarrhoea in rodents [225, 255]. The EO of lavender and its components (linalool, linalyl acetate) and the EO of Cryptomeria japonica (ter-pin-4-ol and elemol) showed protective activities against acute ethanol/aspirin-induced gastric ulcers in rodents [200,254]. 

The author commented that 50-75% of gastrocolic fistulas are related to benign gastric ulcers secondary to the use of NSAIDs. The use of aspirin plus prednisone, as in this patient, increases the risk of complication of peptic ulcer disease two- to fourfold. 

Useful in patients with gastric ulcer who chronically take aspirin. 

ASPIRIN IMMUNOMODULATING DRUGS- CORTICOSTEROIDS Corticosteroids 1 aspirin levels, and therefore there is a risk of salicylate toxicity when withdrawing corticosteroids. Risk of gastric ulceration when aspirin is coadministered with corticosteroids Uncertain Watch for features of salicylate toxicity when withdrawing corticosteroids. Use aspirin in the lowest dose. Remember that corticosteroids may mask the features of peptic ulceration... 

Contraindications fc>r nonsalicylate NSAID therapy are the same as those for aspirin (see Box 7-I).The formation of a gastric ulcer or erosion that may bleed profusely is a serious potential problem with NSAIDs. Consequently, the nonsalicylate NSAIDs should be avoided or used with great caution in patients with active peptic ulcer disease. NSAIDs may increase the risk of GI complications even when used in conjunction with low-dose aspirin for cardioprotection. In addition, because of potential crosssensitivity to other NSAIDs, the nonsalicylate NSAIDs should not be given to patients in whom aspirin or other NSAIDs have caused symptoms of asthma, rhinitis, urticaria, angioedema, hypotension, bronchospasm, or of symptoms of hypersensitivity reactions. Opioids, tramadol, or acetaminophen may be suitable alternatives for patients with known or suspected susceptibility. 

As mentioned earlier, blood losses from menstruation can result in iron deficiency and anemia. Other sources of blood loss arc important as well. The normal rate of blood loss in the feces is 0,5 to 1.0 ml/day. intestinal blood losses can increase in certain cancers. About 60% of the cancers of the colon and rectum lead to further blood losses of 2 to 10 ml/day. The fecal blood test is universally used to screen for the presence of cancer of the gastrointestinal tract- In the absence of periodic testing, cancer may first present as iron deficiency anemia. Duodenal and gastric ulcers, as well as hemorrhoids, arc extremely common sources of blood loss and can result in iron depletion. Aspirin, when consumed in large amounts, can provoke bleeding of the gastrointestinal tract, resulting In blood losses of 1 to 5 ml/day. 

Adverse effects of aspirin are dyspepsia or gastritis and it can cause gastric ulceration. This is because normally prostaglandins inhibit the secretion of stomach acid. 

Side effects occur in 25 to 40% of patients who take tolmetin, and 5 to 10% discontinue use of the drug. Gastrointestinal side effects are the most common (15%) and gastric ulceration has been observed. CNS side effects similar to those seen with indomethacin and aspirin occur, but they are less common and less severe. 

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