85065
document
Omeprazole ameliorates aspirin-induced gastroduodenal injury . Aspirin and nonsteroidal antiinflammatory drugs ( NSAIDs ) damage the gastroduodenal epithelium by two mechanisms : direct toxic effects and effects related to the depletion of endogenous prostaglandins . The prostaglandin-depleted mucosa has increased susceptibility to luminal aggressive factors , yet the role of acid in the pathogenesis of the NSAID ulcer is controversial . In humans , standard doses of H2-receptor antagonists prevent only duodenal injury and provide no protection for the gastric mucosa . It is not known whether more potent suppression of acid can prevent NSAID damage . Twenty healthy volunteers were randomized to a double-blind , placebo-controlled , crossover study to determine if omeprazole , 40 mg/day prevents gastroduodenal injury due to two weeks of aspirin administration ( 650 mg four times a day ) . The severity of mucosal injury was quantitated by endoscopy and stratified by a scale from 0 ( normal ) to 4 ( ulcer ) . Fourteen of the 20 subjects had less gastric injury during cotherapy with omeprazole . All six with no difference received aspirin plus omeprazole in the first treatment period . Omeprazole significantly decreased aspirin-induced gastric mucosal injury ( P < 0.001 , Wilcoxon signed-rank test ) . Omeprazole protected 85 % of subjects from extensive gastric erosions ( often associated with evidence of intraluminal bleeding ) or ulceration , whereas 70 % of the subjects developed aspirin-induced grades 3 and 4 gastric injury on placebo ( P < 0.01 by chi 2 ) . No subject taking omeprazole developed duodenal injury of any grade , while 50 % taking placebo developed erosions and 15 % had ulcer ( P < 0.001 ) . Medication side effects were mild in the majority of subjects . ( ABSTRACT TRUNCATED AT 250 WORDS )
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Intervention_Pharmacological
Omeprazole
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Intervention_Pharmacological
Aspirin and nonsteroidal antiinflammatory drugs ( NSAIDs )
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Intervention_Pharmacological
NSAID
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Intervention_Pharmacological
omeprazole , 40 mg/day
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Intervention_Pharmacological
aspirin administration
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Intervention_Pharmacological
omeprazole .
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Intervention_Pharmacological
omeprazole
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Intervention_Pharmacological
aspirin-induced
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Intervention_Pharmacological
Omeprazole
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Intervention_Pharmacological
aspirin-induced
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Intervention_Pharmacological
omeprazole
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Intervention_Control
placebo
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Outcome_Physical
severity of mucosal injury
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Outcome_Physical
gastric injury
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Outcome_Physical
aspirin-induced gastric mucosal injury
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Outcome_Physical
extensive gastric erosions
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Outcome_Physical
ulceration
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Outcome_Physical
aspirin-induced grades 3 and 4 gastric injury
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Outcome_Physical
duodenal injury of any grade
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Outcome_Physical
erosions
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Outcome_Physical
ulcer
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Participant_Condition
gastroduodenal injury .
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Participant_Condition
Twenty healthy volunteers were randomized