title: Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment.
abstract: OBJECTIVE
  Whether low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage is controversial. Our aim was to determine whether the small bowel is damaged by low-dose ASA on a short-term basis.
  
  
  METHODS
  Twenty healthy volunteers (age range, 19-64 years) underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days. Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.
  
  
  RESULTS
  Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05).
  
  
  CONCLUSIONS
  The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.
authors.affiliation: Department of Medicine, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Smecuol
authors.forename: Maria Ines
authors.initials: MI
authors.lastname: Pinto Sanchez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Suarez
authors.forename: Julio E
authors.initials: JE
authors.lastname: Argonz
authors.forename: Emilia
authors.initials: E
authors.lastname: Sugai
authors.forename: Horacio
authors.initials: H
authors.lastname: Vazquez
authors.forename: Nestor
authors.initials: N
authors.lastname: Litwin
authors.forename: Elena
authors.initials: E
authors.lastname: Piazuelo
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Meddings
authors.forename: Julio C
authors.initials: JC
authors.lastname: Bai
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D053704:Capsule Endoscopy; D005243:Feces / Q000737:chemistry; D005260:Female; D005947:Glucose / Q000378:metabolism; D064368:Healthy Volunteers; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D007421:Intestine, Small / Q000187:drug effects* / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013395:Sucrose / Q000378:metabolism; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D039841:Leukocyte L1 Antigen Complex; D013395:Sucrose; D005947:Glucose; D001241:Aspirin