What is the most effective therapy for low-dose aspirin induced peptic ulcer?

21 feb 2009--The incidence of low-dose aspirin-induced peptic ulcer seems to be increasing in Japan in conjunction with the increasing proportion of elderly individuals, in whom metabolic syndrome frequently develops. However, a therapeutic and prevention strategy for such peptic ulcers has not yet been established.

A research team led by Dr. Satoshi Mochida from Japan addressed this question. Their study will be published on February 14, 2009 in the World Journal of Gastroenterology.

In their study, Upper gastrointestinal endoscopy was performed in 68 patients receiving daily low-dose aspirin (81 or 100 mg/day). The endoscopic findings were classified according to the Lanza score, and the scores were compared between groups categorized according to the concomitant use of anti-ulcer drugs and the types of drugs used. In another study, 31 hemorrhagic peptic ulcer patients who had been receiving low-dose aspirin were enrolled. The patients were randomly classified into the proton pump inhibitor (PPI)-treated group and the H2 receptor antagonist (H2RA)-treated group. The administration of low-dose aspirin was continued concomitantly, and endoscopic examinations were performed 8 wk later.

They found that the Lanza scores (mean ± SD) of the gastro-mucosal lesions were 1.0 ± 1.9 and 1.9 ± 2.3 in 8 and 16 patients receiving prevention therapy with a PPI and an H2RA, respectively. Both scores were significantly smaller than the scores in 34 patients who were not receiving prevention therapy (4.7 ± 1.0) and in 10 patients receiving cytoprotective anti-ulcer drugs (4.3 ± 1.6). In the prospective study, 18 and 13 patients received a PPI and an H2RA, respectively. Endoscopic examinations revealed that the tissue in the region of the gastro-mucosal lesions had reverted to normal in all patients in the PPI-treated group and in 12 patients (92%) in the H2RA-treated group; no significant differences were observed between the groups.

Their results indicated that H2RA therapy was effective for both the prevention and treatment of low-dose aspirin induced peptic ulcers, similar to the effects of PPIs, while cytoprotective anti-ulcer drugs were ineffective in preventing peptic ulcers.

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Reference: Nakashima S, Ota S, Arai S, Yoshino K, Inao M, Ishikawa K, Nakayama N, Imai Y, Nagoshi S, Mochida S. Usefulness of anti-ulcer drugs for the prevention and treatment of peptic ulcers induced by low doses of aspirin. World J Gastroenterol 2009; 15(6): 727-731 http://www.wjgnet.com/1007-9327/15/727.asp

Correspondence to: Satoshi Mochida, MD, PhD, Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama 350-0495, Japan. smochida@saitama-med.ac.jp