title: Use of microbleeding and an ultrathin endoscope to assess gastric mucosal protection by famotidine.
abstract: We have developed an ultrathin endoscope for repeated endoscopy in unsedated subjects and used it with assessment of bleeding rates to investigate aspirin-induced gastric mucosal injury and its prevention by famotidine. Compared with placebo, 900 mg of aspirin b.i.d. taken for 48 h caused significant endoscopic injury (median grade 3.5, interquartile range 2-4, modified Lanza scale, p less than 0.01), with an increase in mucosal bleeding from 2.0 (geometric mean; 95% confidence limits, 1.1-3.9) microliters/12 min, to 8.3 (2.4-28.8) microliters/12 min (p less than 0.05). Famotidine (20 mg b.i.d.) raised intragastric pH and reduced endoscopic antral injury (median 1.5, interquartile range 0.5-2, p less than 0.05) and bleeding [3.1 (1.2-8.3) microliters/12 min, p less than 0.01] to levels not significantly different from placebo [1 (0-1) and 2.0 (1.1-3.9) microliters/12 min, respectively]. By contrast, 2 mg of famotidine b.i.d. had no significant effect on intragastric pH endoscopic injury or bleeding rates. The two assessments of gastric mucosal injury correlated strongly (r = 0.71, p less than 0.01). The reduction in bleeding with famotidine tended to be higher, the greater the intragastric pH (r = 0.66, p = 0.057). Ultrathin endoscopy is a simple technique that validates gastric mucosal bleeding as a measure of acute gastric mucosal injury in humans. Acid suppression is an effective method of ameliorating this injury.
authors.affiliation: Department of Therapeutics, University Hospital, Nottingham, United Kingdom.
authors.forename: T K
authors.initials: TK
authors.lastname: Daneshmend
authors.forename: P J
authors.initials: PJ
authors.lastname: Prichard
authors.forename: N K
authors.initials: NK
authors.lastname: Bhaskar
authors.forename: P J
authors.initials: PJ
authors.lastname: Millns
authors.forename: C J
authors.initials: CJ
authors.lastname: Hawkey
mesh_terms: D000293:Adolescent; D000328:Adult; D001241:Aspirin / Q000009:adverse effects; D004311:Double-Blind Method; D015738:Famotidine; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D020699:Gastroscopes; D005773:Gastroscopy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D013844:Thiazoles / Q000627:therapeutic use*
chemical_list: D006635:Histamine H2 Antagonists; D013844:Thiazoles; D015738:Famotidine; D001241:Aspirin