Low-Dose Aspirin Affects the Small Bowel Mucosa: Results of a Pilot Study With a Multidimensional Assessment
published online 29 December 2008.
Background & Aims
Whether low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage is controversial. Our aim was to determine whether the small bowel is damaged by low-dose ASA on a short-term basis.
Methods
Twenty healthy volunteers (age range, 19–64 years) underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days. Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.
Results
Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011–0.045) increased after ASA use (0.036; range, 0.007–0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 μg/g; range, 1.9–79.2) also increased significantly after ASA use (23.9 μg/g; range, 3.1–75.3; P < .0005), with 3 patients having values above the cutoff (>50 μg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8–151.3) increased significantly after ASA administration (107.0 mg; range, 22.9–411.3; P < .05).
Conclusions
The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.
⁎Department of Medicine, Hospital de Gastroenterología “Dr. Carlos Bonorino Udaondo”, Buenos Aires, Argentina
‡Department of Gastroenterology, University Hospital, Instituto Aragonés de Ciencias de la Salud CIBERehd, Zaragoza, Spain
§Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Reprint requests Address requests for reprints to: Dr Angel Lanas, Servicio de Aparato Digestivo, Hospital Clínico Universitario de Zaragoza, C/ San Juan Bosco 15, 50009 Zaragoza, Spain. fax: (34) 976-762539
Conflicts of interest Dr Lanas is advisor to Pfizer, AstraZeneca, and Bayer. The remaining authors disclose no conflicts.
Funding This independent study was supported by the Grupo de Investigación en Gastroenterologia from the Instituto Aragones de Ciencias de la Salud and the CIBERehd (Zaragoza, Spain).
ABSTRACT