Can Low Dose Aspirin Cause Stomach Problems


Assessing Your Likelihood Of Developing Gi Side Effects From Nsaids

Aspirin triggers increased risk of bleeding and stroke for older people

For some arthritis patients, NSAIDs may not be an option because of other health issues.

Typically, if someone has a history of peptic ulcers, gastrointestinal bleeding, or Barretts esophagus, NSAIDs should be avoided, Dr. Bhana says. Anyone who is on blood thinners or will be undergoing surgery may need to avoid these medications as well, he adds, because the risk of life-threatening bleeding is significantly higher.

Other medications that may increase your risk of bleeding when taken with NSAIDs include low-dose aspirin , selective serotonin reuptake inhibitors such as Prozac and Paxil, and glucocorticoids.

If your doctor determines you shouldnt take oral NSAIDs, he or she may recommend other therapies for pain relief.

There are topical NSAIDs, such as diclofenac, that may be helpful for localized arthritic pain, Dr. Bhana. These have a low rate of systemic absorption and are safer for your stomach.

Non-NSAID analgesics such as acetaminophen may also be an option.

The Effects Of Aspirin And Acetaminophen On The Stomach In Healthy Volunteers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
First Posted : January 16, 2008Last Update Posted : May 15, 2019

Aspirin is a medication commonly used to relieve minor pains. Aspirin has also been used to prevent heart attacks and strokes. Aspirin, however, can also cause damage to the stomach and/or intestinal lining leading to the development of erosions and/or ulcers . Erosions may cause bleeding and/or perforations . Acetaminophen, often referred by the brand name, Tylenol, is also used to treat minor pains but is not commonly recognized to cause damage to the stomach lining.

Many patients often take both of these medications together. While the effects on the stomach lining of each medication, when used alone, are known, the effects of both medications, when used together, are not.

The purpose of this study is to show whether or not the collective effects of both aspirin and acetaminophen, when used together, increase the damage on the stomach lining when compared to either medication alone.

  • Active GI disease , or a history of GI ulcers or bleeding
  • History of gastric or intestinal surgery
  • Positive FOBT at baseline.
  • How Safe Is Aspirin

    As with many medications, aspirin has negative effects. It irritates the lining of your stomach and can cause gastrointestinal discomfort, ulcers, and bleeding. Furthermore, because it thins the blood, it can be problematic for persons who are predisposed to bleeding. Finally, like other non-steroidal anti-inflammatory drugs , aspirin can lead to serious complications if you should take it by itself or in conjunction with other medications that contain acetylsalicylic acid . For example, people who suffer from heart disease or who have had a stroke should not take aspirin unless they discuss their therapy with their doctor or nurse practitioner.

    Aspirin’s effectiveness as an analgesic makes it one of the most popular over-the-counter medications. However like any drug, it can cause adverse effects. Some of the more common side effects include: nausea, diarrhea, constipation, dry mouth, increased risk of bleeding during surgery, increased risk of bleeding from wounds, bruises, or IV lines allergic reactions such as skin rashes, hives, or itching problems with vision and fatigue. As always, if you experience any symptoms that concern you while taking aspirin, contact your doctor immediately.

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    Think It’s A Heart Attack Call 911 Then Chew An Aspirin

    Whether or not you take daily low-dose aspirin, keep a stash of regular, full-strength aspirin handy. Why? If you think you’re having a heart attack, doctors recommend chewing an aspirin, right after you call 911. If you don’t have 325-mg pills, take four low-dose pills. Failing that, most emergency medical services will give you one en route to the hospital or once you’re there.

    Chewing the pills gets the anti-clotting chemicals into your bloodstream much faster than if you swallow it. In one study, platelet activity dropped by 50% within five minutesin people who chewed an aspirin. That same effect took 12 minutes if the aspirin wasswallowed whole.

    Whats The Bottom Line

    Aspirin 101

    The best way to know if you can benefit from aspirin therapy is to ask your health care provider. You should not start aspirin on your own.

    Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.

    Last Reviewed: Mar 20, 2019

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    The Benefits And Risks Of Daily Aspirin

    Daily aspirin therapy, where you take a low dose of aspirin every day, may reduce your risk of heart attack or stroke. Aspirin works by interfering with your bloods clotting action. Clots typically form when you bleed to stop bleeding. However, when clots form in your heart or brain and block the blood flow to these areas, heart attacks or strokes occur. By interfering with clot formation, aspirin can help prevent these diseases.

    What is daily aspirin therapy?Daily aspirin therapy is prescribed to certain patients to reduce the risk of forming blood clots that can cause future health problems. A low dose of daily aspirin can range from 81mg to 325mg depending on your condition and other medications you may be taking. However, daily aspirin therapy does come with some risks. Always talk to your doctor to find out if daily aspirin therapy is right for you and what dose you should take.

    Who would benefit from daily aspirin therapy?It was previously believed that daily aspirin therapy is an easy way to prevent heart attacks and strokes for everyone at risk however, a series of recently published studies proved otherwise. If you have already had a heart attack or a stroke, you should remain on daily aspirin therapy as recommended by your doctor to prevent a second event.

    Never start taking daily aspirin without talking to your doctor first to discuss the risks and the benefits.

    For more information about daily aspirin therapy, visit:

    Is Lda Really Harmful To The Small Bowel In Humans

    Although aspirin use, including LDA use, has been shown to increase the risk of gastroduodenal ulcers, it is generally believed that aspirin is safe for the small bowel beyond the duodenum. The topical effect of aspirin was estimated to be mainly limited to the gastroduodenum due to the rapid absorption of aspirin in the stomach and the duodenum, and the lack of enterohepatic recirculation . Experimental studies have shown that aspirin does not induce damage of the small bowel. For the case of human beings, a number of noninvasive tests have been developed to evaluate the indirect parameters of mucosal damage such as measurement of the intestinal permeability or surrogate markers of inflammation in stools. Studies investigating intestinal damage have been performed in a limited number of aspirin users and shown little evidence of increased intestinal permeability . Increased intestinal mucosal permeability has been observed in patients taking high-dose aspirin , however, data showing that low-dose aspirin induces intestinal damage are scarce and controversial. Leung et al. reported a case of severe enteropathy induced by LDA, which changed our perception based on intestinal permeability and fecal inflammatory marker studies that aspirin does not cause small bowel damage.

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    Even Low Dose Of Aspirin Can Cause Intestinal Bleeding

    Nov. 9, 2000 — An aspirin a day may preventheart attack and stroke, but not without potentially serious risks of intestinal bleeding. And now some researchers say that even fairly low doses of aspirin can increase the risk for bleeding in the gut.

    While the risk of bleeding associated with long-term aspirin use has been widely recognized, it now appears that even fairly low doses — which some people may have considered safe — increases the risk, say Yoon Kong Loke, MBBS, and Sheena Derry, MBBS, of the department of clinical pharmacology at the University of Oxford in England.

    “We have known for a long time that patients on aspirin face the risk of gastrointestinal bleeding,” Loke tells WebMD. “Doctors have tried to get around this problem by recommending the use of smaller doses. Many people believe that the low doses of aspirin, such as 75 mg a day, carry little risk of side effects as compared to the 300 mg and 900 mg doses used in the past. To our surprise, we found that low doses of aspirin were just as likely to cause gastrointestinal bleeding as the high doses.”

    Loke also has disappointing news for those hoping to duck the risk of bleeding by using so-called “enteric-coated” aspirin, which have been considered to be somewhat safer than regular aspirin: They aren’t. “We found no evidence that these formulations reduced the risk of gastrointestinal bleeding,” he tells WebMD.

    Difference In The Incidence Of Small Bowel Injury Between Patients Receiving Buffered Aspirin And Those Receiving Enteric

    Aspirin & heart disease

    In order to reduce the incidence of gastrointestinal injury in LDA users, it is important for clinicians to confirm the differences in the gastrointestinal toxicity between different types of aspirin formulations in clinical use. To potentially avoid gastric mucosal injury caused by the topical irritant effect of aspirin, two types of formulations have been developed and are widely used. Buffered products contain agents such as calcium carbonate, magnesium oxide, and magnesium carbonate, which lower the hydrogen ion concentration of the aspirin particles. The low hydrogen ion concentration increases the gastric solubility of aspirin, thereby decreasing the contact time between aspirin and the gastric mucosa . On the other hand, it has been postulated that enteric-coated formulations of aspirin, which are designed to cancel disintegration in an acid environment and pass through the stomach without undergoing dissolution, may also reduce the risk of gastric injury. Several studies have reported that enteric-coated aspirin causes less severe gastroduodenal injury than uncoated aspirin however, the precise difference in the severity of the small bowel toxicity between these two types of formulations remains unknown.

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    I Asked My Husband To Take Me To The Emergency Room Because The Pain Was So Bad That I Felt Like I Was Being Stabbed

    For many arthritis patients, taking non-steroidal anti-inflammatory drugs, or NSAIDs, can play a big role in relieving pain and inflammation and improving quality of life. But like any medication, NSAIDs arent risk-free. Perhaps their most commonly known and potentially dangerous side effect is irritation of the stomach lining, which protects the stomach from the acid it produces to help digest your food.

    Over-the counter and prescription NSAIDs are generally well-tolerated when used as instructed, says Suleman Bhana, MD, FACR, a rheumatologist at Crystal Run Healthcare in Middletown, New York. That said, nearly all NSAIDs can cause GI side effects, so ideally patients should take the lowest possible tolerable dose as infrequently as possible.

    Below, Dr. Bhana explains why these gastrointestinal side effects from NSAIDs occur, whos at the greatest risk of developing them, and what you can do to protect yourself.

    Risk Factors For Small Bowel Mucosal Breaks In Chronic Lda Users

    For the prevention of small bowel injury in patients receiving LDA, it is important to identify the risk factors for the development of such injury in these patients. In regard to the upper gastrointestinal complications associated with aspirin use, it is well recognized that not all patients receiving LDA are at an equivalent risk of developing these complications, and several factors such as advanced age, history of peptic or bleeding ulcer, concomitant use of NSAIDs/other antiplatelet agents/anticoagulants, presence/absence of severe co-morbidities, and high-dose aspirin use, have been reported to influence the risk . Some key strategies have been proposed to minimize the upper-gastrointestinal adverse effects of LDA, such as reducing the influence of modifiable risk factors, reducing the aspirin dose, and concomitant use of a gastroprotective agent, preferably a proton pump inhibitor . However, there are few data on the risk factors for the development of small bowel injury among patients receiving LDA.

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    Gastrointestinal Adverse Effects Of Aspirin

    The widespread use of aspirin by older people has historically been limited as many develop abdominal side effects. Almost 50% of those prescribed aspirin for secondary prevention report gastrointestinal symptoms after just 2 weeks of use and almost one-third of aspirin users have endoscopically visible lesions within one hour of ingestion . Symptoms are recognized as a poor predictor for gastrointestinal lesions with 48% of asymptomatic aspirin users having lesions visible at endoscopy.

    Aspirin can lead to adverse gastrointestinal effects ranging from dyspepsia with endoscopically normal gastric mucosa, asymptomatic and symptomatic lesions such as erosions and ulcers, and complications of ulcers including bleeding and perforation. Although these gastrointestinal effects are dose dependant, even lower doses of aspirin are being increasingly recognized as a cause of gastrointestinal bleeding .

    It is controversial, however, whether simply being old makes you more susceptible to aspirin-induced gastrointestinal damage or whether comorbidity, comedications, and past history are more important predictors of toxicity than age and perhaps more relevant to therapeutic decision making in this population . Risk factors for aspirin-induced gastrointestinal complications are shown in Table 1.

    Prevents Clots From Forming Growing

    Countdown Pharmacy

    Most heart attacks and strokes happen when a blood clot forms and blocks blood flow in an artery. Under normal circumstances, the body develops a blood clot to stop the loss of blood after an injury. When a blood vessel is damaged, sticky cells called platelets begin to clump together, while proteins in the blood form strands of fibrin. The fibrin creates a net-like structure that holds the forming clot together. Blood clots can form in damaged vessels of the heart or the brain, and these can block blood to the tissue and cause a heart attack or stroke. Aspirin stops clots from forming by preventing the platelets from clumping together.

    If you have had a heart attack or stroke, your doctor may prescribe low-dose aspirin to prevent a second event. Low-dose aspirin has been shown to reduce the risk of a first heart attack but has not been definitively proven to reduce the risk of a stroke. Speak with your physician before starting low-dose aspirin for prevention.

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    Dont Take More Than The Recommended Dosage

    NSAID overuse isnt rare: A 2018 study published in the journal Pharmacoepidemiology and Drug Safety revealed that 15 percent of adult users of ibuprofen exceed the maximum recommended dose of ibuprofen or other NSAIDs in a one-week period.

    This was typically the result of taking too much of a single NSAID at one time, taking two different NSAIDs simultaneously, or failing to wait long enough before taking another dose. Overuse increases your risk of developing GI side effects from NSAIDs, so be sure to follow your doctors directions to the letter.

    Should I Take Aspirin During A Heart Attack Or Stroke

    The more important thing to do if any heart attack warning signs occur is to call 911 immediately. Don’t do anything before calling 911. In particular, don’t take an aspirin, then wait for it to relieve your pain. Don’t postpone calling 911. Aspirin won’t treat your heart attack by itself.

    After you call 911, the 911 operator may recommend that you take an aspirin. He or she can make sure that you don’t have an allergy to aspirin or a condition that makes using it too risky. If the 911 operator doesn’t talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it’s right for you.

    Taking aspirin isn’t advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptured blood vessels. Taking aspirin could potentially make these bleeding strokes more severe.

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    What Aspirin Is Used For

    At high doses aspirin can:

    • reduce a high temperature
    • reduce swelling

    Long-term treatment with low doses of aspirin has an antiplatelet effect. This means it makes the blood less sticky and can stop blood clots developing.

    A doctor may recommend this if you have or have had:

    Aspirin may also be prescribed for children after heart surgery or to treat Kawasaki disease. It shouldn’t be given to anyone under 16 years old without medical supervision.

    Strategies To Improve Tolerability: The Eradication Of Helicobacter Pylori

    Advice Shifting On Aspirin Use For Preventing Heart Attacks

    Many changes in gastrointestinal physiology once thought to be primary effects of aging have been reexamined since the discovery of the microorganism Helicobacter pylori . Infection with H. pylori itself induces changes in gastrointestinal physiology, which is of relevance when it is appreciated that in the Western world infection rates increase with age, with up to 80% of 80-year-old subjects infected .

    Both aspirin use and H. pylori infection cause peptic ulcers, but whether the incidence is greater when both are present is unclear . H. pylori and aspirin are independent risk factors for ulceration in all age groups , however, studies specifically involving older people suggest that there may be a synergistic effect on risk .

    Low doses of aspirin induced endoscopically visible upper gastrointestinal mucosal damage more frequently in H. pylori positive subjects compared with 16% of H. pylori negative volunteers . Furthermore, eradication of H. pylori reduces damage caused by low doses of aspirin and recurrence of ulcers during aspirin use and improves adaptability of the gastrointestinal tract to aspirin . Unfortunately, H. pylori eradication will not always improve aspirin tolerability, as gastrointestinal symptoms, ulcers, and their complications are associated with aspirin use in those with, and without, H. pylori infection .

    Proposed algorithm to improve gastrointestinal tolerance of aspirin in older people.

    Abbreviations: PPI, proton pump inhibitor.

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