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Relationship of low-dose aspirin to GI injury and occult bleeding: a pilot study
P D Greenberg1, J P Cello, D C Rockey
1Division of Gastroenterology, Hepatology and Clinical Nutrition, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, USA.
Insights
Low-dose aspirin, commonly used for cardiovascular health, does not typically cause significant gastrointestinal injury or positive fecal occult blood tests in healthy volunteers. These findings suggest aspirin can be continued during stool testing for occult blood.
Area of Science:
- Gastroenterology
- Cardiology
- Clinical Pharmacology
Background:
- Low-dose aspirin is widely prescribed for cardiovascular disease prevention.
- The impact of aspirin on gastrointestinal (GI) injury and occult blood loss remains incompletely understood.
- This study investigated aspirin's effects on endoscopic GI lesions and fecal occult blood loss.
Purpose of the Study:
- To evaluate the incidence of endoscopic gastrointestinal injury in healthy volunteers taking varying doses of low-dose aspirin.
- To assess the effect of low-dose aspirin on fecal occult blood test results.
- To determine if low-dose aspirin interferes with common fecal occult blood tests.
Main Methods:
- A randomized, double-blind, placebo-controlled pilot study involving 40 healthy volunteers.
- Participants received daily doses of aspirin (30 mg, 81 mg, 325 mg) or placebo for 30 days.
- Upper endoscopy and fecal occult blood testing (guaiac and immunochemical methods) were performed before and after treatment.
Main Results:
- Aspirin did not lead to statistically significant endoscopic injury compared to placebo.
- Aspirin use was not associated with positive fecal occult blood tests across multiple testing methods.
- The 325 mg aspirin dose showed a trend toward higher symptom scores, but no significant endoscopic findings.
Conclusions:
- Commonly used low-dose aspirin regimens for cardiovascular prophylaxis generally do not cause significant upper GI mucosal lesions.
- In the absence of overt ulceration, low-dose aspirin does not typically yield false-positive fecal occult blood tests.
- Low-dose aspirin is unlikely to interfere with fecal occult blood testing and may not require discontinuation for stool collection.
Background:
Low-dose aspirin is commonly used in patients with cardiovascular disease. However, little is known about the effect of aspirin on occult blood loss caused by gastrointestinal injury. Therefore, we studied endoscopic injury and fecal occult blood loss in patients ingesting different quantities of low-dose aspirin.
Methods:
Forty healthy volunteers were enrolled in a randomized, double-blind, prospective, pilot endoscopic study. Each volunteer underwent 30 days of treatment with daily aspirin 30 mg, 81 mg, 325 mg, or placebo. Subjects completed fecal occult blood test cards before and at the end of treatment of two types: guaiac impregnated (Hemoccult and Hemoccult SENSA) and immunochemical (HemeSelect and FlexSure OBT). Each volunteer underwent upper endoscopy at baseline and after completing 30 days of study medication.
Results:
Aspirin did not induce significant injury as determined by endoscopy when compared with placebo. Six of 30 volunteers taking aspirin developed erosions, whereas 1 of 10 subjects on placebo developed a new erosion (p = 0.66). Aspirin (325 mg) was associated with a higher mean symptom score than the lower aspirin dosages and the placebo group (p = 0.12). Only one subject taking aspirin (325 mg) had fecal occult blood on a single HemeSelect card. No subject had a positive fecal occult blood test with Hemoccult II, Hemoccult II SENSA, or FlexSure OBT cards.
Conclusions:
Aspirin in dosages commonly used for cardiovascular prophylaxis does not generally cause significant gastric or duodenal mucosal endoscopic lesions. In the absence of frank ulceration, low-dose aspirin does not result in positive fecal occult blood tests. Low-dose aspirin should not interfere with fecal occult blood testing and probably should not be stopped during stool collection.