Key result
Half-dose proton pump inhibitors (lansoprazole or rabeprazole) significantly prevented aspirin-induced esophageal mucosal injury compared to aspirin alone (0% and 6.7% vs 46.7%).
Why the study?
Does concomitant acid inhibition with famotidine, lansoprazole, or rabeprazole prevent esophageal mucosal injury induced by low-dose aspirin in healthy volunteers?
RCT (n=15)
random crossover
Does concomitant acid inhibition with famotidine, lansoprazole, or rabeprazole prevent esophageal mucosal injury induced by low-dose aspirin in healthy volunteers?
Absolute Event Rate: 0% vs 46.7%
p-value: p=0.004
Half-dose proton pump inhibitors effectively prevent low-dose aspirin-induced esophageal mucosal injury, whereas standard-dose H2-receptor antagonists do not.
Half-dose PPIs merit consideration with low-dose aspirin to avert esophageal injury; extends gastroprotection evidence to the esophagus in this RCT.
BACKGROUND AND AIM: Aspirin enjoys widespread use as an antithrombotic drug, but such ubiquity also increases the risk of gastrointestinal mucosal injury. Recent studies have shown that aspirin can also induce esophageal mucosal injury. We resolved to determine the intragastric pH value necessary to prevent aspirin-induced esophageal mucosal injury. METHODS: 15 healthy Japanese volunteers were dosed for 7 days in a four-way random crossover trial with 100 mg entero-coated type aspirin only once daily, 100 mg aspirin + 20 mg famotidine twice daily, 15 mg lansoprazole once daily, or 10 mg rabeprazole once daily. All subjects underwent endoscopy and intragastric pH monitoring on day 7. RESULTS: 7 individuals (46.7%) developed esophageal mucosal injury when ingesting aspirin alone. The incidence of esophageal mucosal injury was reduced however with concomitant dosing of aspirin and famotidine (26.6%; p = 0.193), lansoprazole (0%; p = 0.004), and rabeprazole (6.7%; p = 0.019). Among individuals for whom mean 24-h pH was >5.0 and who experienced pH <4.0 less than 40% of the time, none developed aspirin-induced esophageal mucosal injury. CONCLUSION: Acid inhibition achieved with a half-dose of a proton pump inhibitor effectively prevented development of aspirin-induced esophageal mucosal injury, whereas a standard dose of a histamine-2-receptor antagonist failed to achieve the same results.
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Sugimoto et al. (2011) conducted an RCT in Healthy volunteers (aspirin-induced esophageal mucosal injury) (n=15). Acid inhibition (famotidine, lansoprazole, or rabeprazole) vs. Aspirin 100 mg once daily alone was evaluated on esophageal mucosal injury (p=0.004). Half-dose proton pump inhibitors (lansoprazole or rabeprazole) significantly prevented aspirin-induced esophageal mucosal injury compared to aspirin alone (0% and 6.7% vs 46.7%).
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