Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment.
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.
Smecuol
Edgardo
E
Department of Medicine, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina.
Pinto Sanchez
Maria Ines
MI
Suarez
Alejandro
A
Argonz
Julio E
JE
Sugai
Emilia
E
Vazquez
Horacio
H
Litwin
Nestor
N
Piazuelo
Elena
E
Meddings
Jonathan B
JB
Bai
Julio C
JC
Lanas
Angel
A
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
D000893:Anti-Inflammatory Agents; D039841:Leukocyte L1 Antigen Complex; D013395:Sucrose; D005947:Glucose; D001241:Aspirin