Occult GI Bleeding in NSAID Users—The Base of the Iceberg!

The first account of the adverse effects of aspirin on the stomach appeared in The Lancet in 1938.¹ Shortly afterward, Hurst and Lindtott² noted aspirin’s then-unexplained tendency to cause gastrointestinal bleeding. Another 20 years passed before Duggan in Australia³ noted retrospectively a close connection between aspirin consumption and the occurrence of an epidemic in young women in the 1940s of gastric but not duodenal ulcers. These observations soon were confirmed in many other countries. In these studies, affected patients usually were consuming relatively large amounts of aspirin. On later analysis by Graham and Lacey-Smith,⁴ the association between clinical gastric ulcers—as diagnosed by radiology or surgery—was not seen in those consuming fewer than 14 tablets a week, and was not statistically significant at fewer than 22 tablets per week (3 tablets/day).