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Drugs and gastric damage.

A R Cooke

    Drugs
    |January 1, 1976
    PubMed
    Summary

    Unbuffered aspirin may cause gastric ulcers and bleeding, though infrequently. Buffered aspirin and newer substitutes appear safer, while smoking is linked to ulcers, but the mechanism remains unclear.

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    Area of Science:

    • Gastroenterology
    • Pharmacology
    • Toxicology

    Background:

    • The gastric mucosa is vulnerable to various exogenous agents.
    • Understanding drug-induced gastropathy is crucial for patient safety.
    • Previous studies have indicated potential risks associated with common medications and substances.

    Purpose of the Study:

    • To review the effects of common drugs and substances on gastric mucosa.
    • To evaluate the association between these agents and gastric damage, including ulcers and bleeding.
    • To assess the evidence for ulcerogenicity of aspirin, smoking, and other medications.

    Main Methods:

    • Literature review of studies investigating the impact of aspirin, salicylate substitutes, smoking, indomethacin, corticosteroids, phenylbutazone, ethanol, caffeine, and reserpine on gastric mucosa.
    • Analysis of effects on gastric mucosal barrier, erosions, microbleeding, haematemesis, melaena, and peptic ulcer formation.
    • Evaluation of incidence rates and comparative safety profiles.

    Main Results:

    • Unbuffered aspirin shows suggestive evidence of causing haematemesis, melaena, and gastric ulcers, with low hospital admission rates.
    • Buffered aspirin (acetylsalicylate) at neutral pH protects against gastric damage.
    • Newer aspirin substitutes may cause less fecal blood loss, but long-term data is limited. Smoking is strongly associated with peptic ulcers.
    • Corticosteroids are likely not ulcerogenic, contrary to clinical belief. Indomethacin and phenylbutazone have insufficient evidence for firm conclusions.
    • Ethanol, caffeine, and reserpine appear unlikely to be ulcerogenic based on available data.

    Conclusions:

    • While unbuffered aspirin carries a risk of gastric bleeding and ulcers, its incidence is low. Buffered aspirin and newer substitutes offer potential protection.
    • Smoking is a confirmed risk factor for peptic ulcers, though its mechanism is not fully understood.
    • Current evidence suggests corticosteroids, ethanol, caffeine, and reserpine are unlikely to be ulcerogenic, while the role of indomethacin and phenylbutazone requires further investigation.

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