Upper Digestive Mucosal Changes in Patients Taking Low-dose Aspirin

Objective: The benefits of antiplatelet therapies for treatment and prevention of cardiovascular diseases have been demonstrated in the last years, but these therapies increase the risk of mucosal damage in the gastrointestinal tract. We aimed to evaluate endoscopic mucosal lesions in patients not referred for endoscopy, with a new recommendation for long term low-dose aspirin, who have not taken the drug before endoscopy and in patients taking long-term low-dose aspirin.
Material and methods: Two-hundred twenty-five patients who had accepted an endoscopy were included (90 with low-dose aspirin, 135 with recommendation for low-dose aspirin). With few exceptions, there were no statistically significant differences in patient groups regarding social habits, chronic diseases, ulcer history, concomitant drug or digestive symptoms.
Results: Severe Lanza scores were significantly more frequent in patients with low-dose aspirin than in patients without aspirin (60% vs. 30.4%, p<0.01). In patients with chronic low-dose aspirin, H. pylori infection was significantly less frequent than in patients not taking this therapy (38.9% vs. 50.4%, p=0.05), while gastric atrophy and/or intestinal metaplasia were more frequent (48.9% vs. 36.3%, p=0.04). Active infection with H. pylori in taken biopsies was associated with more severe lesions, including ulcers, in both groups, while gastric atrophy and/or intestinal metaplasia were significantly associated with severe endoscopic lesions in patients with low-dose aspirin.
Conclusions: Patients with recommendation for long term treatment with low-dose aspirin frequently present severe mucosal endoscopic lesions and multiple risk factors for gastrointestinal complications before starting the treatment. Patients taking low-dose aspirin on a daily basis present more severe endoscopic lesions when an active H. pylori infection and premalignant histological changes are present.