The Epidemiological Evaluation of Major Upper Gastrointestinal Bleeding in Relation to Aspirin Use

  • Micha Levy
Conference paper


Forty years of kilotons of aspirin (ASA) use passed before Douthwaite’s first report appeared (Douthwaite 1938), suggesting that the drug causes major upper gastrointestinal bleeding (GIB). The patient was a 41-year-old doctor, who, “on account of supra-orbital neuritis, kept himself going in his practice by taking aspirin for 10 days” until melena occurred. Radiographic examinations of the alimentary tract were normal. He had never suffered from indigestion and made a complete recovery. In the following year, Douthwaite, Lintott, and Hurst (Douthwaite and Lintott 1938; Hurst and Lintott 1939) observed on gastroscopy hemorrhagic gastritis in several patients following the use of ASA. In 1943, Hurst considered that in half of the cases he had seen with gastric bleeding, aspirin was the cause. However, the gastroscopio findings were not confirmed by Paul (1943) or by Wolf and Wolff (1943), who failed to observe local reaction when they applied “powdered ASA pills” to the gastric mucosa of their famous patient “Tom”.


Aplastic Anemia Acute Gastrointestinal Bleeding Habitual Intake Epidemiological Evaluation Boston Collaborative Drug Surveillance Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Allan R, Dykes P (1976) A study of the factors influencing mortality rates from gastrointestinal hemorrhage. J Med 45: 533Google Scholar
  2. Allibone A, Flint FJ (1958) Bronchitis, aspirin, smoking and other factors in the aetiology of peptic ulcer. Lancet 2:179PubMedCrossRefGoogle Scholar
  3. Alvarez AS, Summerskill WHJ (1958) Gastrointestinal haemorrhage and salicylates. Lancet 2:920PubMedCrossRefGoogle Scholar
  4. Anderson JA (1972) Separate sample logistic discrimination. Biometrika 58:19CrossRefGoogle Scholar
  5. Aspirin Myocardial Infarction Study Research Group (1980) A randomized, controlled trial of aspirin in persons recovered from myocardial infarction. JAMA 243: 661CrossRefGoogle Scholar
  6. Brown RK and Mitchell N (1956) The influence of some of the salicyl compounds (and alcoholic beverages) on the natural history of peptic ulcer. Gastroenterology 31:198PubMedGoogle Scholar
  7. Coggon D, Langman MJS, Spiegelhalter D (1982) Aspirin, paracetamol and haematemesis and melena. Gut 23:340PubMedCrossRefGoogle Scholar
  8. Crook JN, Gray LW, Nance FC, Cohn I (1972) Upper gastrointestinal bleeding. Ann Surg 175:771PubMedCrossRefGoogle Scholar
  9. Douthwaite AH (1938) Some recent advances in medical diagnosis and treatment. Br Med J 1:1143PubMedCrossRefGoogle Scholar
  10. Douthwaite A, Lintott GAM (1938) Gastroscopic observations of the gastric mucosa after use of aspirin. Lancet 2:1222CrossRefGoogle Scholar
  11. Goodman LS, Gilman A (1975) The pharmacological basis of therapeutics, 5th ed. Macmillan, New YorkGoogle Scholar
  12. Hurst A (1943) Aspirin and gastric haemorrhage. Br Med J 1:768CrossRefGoogle Scholar
  13. Hurst A, Lintott GAM (1939) Aspirin as a cause of hematemesis. Guy’s Hosp Rep 89:173Google Scholar
  14. International Agranulocytosis and Aplastic Anemia Study (1983) The design of a study of the drug etiology of agranulocytosis and aplastic anemia. Europ J Clin Pharmacol 24: 833CrossRefGoogle Scholar
  15. Jick H (1981) Effects of aspirin and acetaminophen in gastrointestinal hemorrhage. Arch Intern Med 141: 316PubMedCrossRefGoogle Scholar
  16. Katon RM, Smith FW (1983) Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding. Gastroenterology 65: 728Google Scholar
  17. Kelly JJ Jr (1956) Salicylate ingestion: a frequent cause of gastric hemorrhage. Am J Med Sci 232: 119PubMedCrossRefGoogle Scholar
  18. Lange HF (1957) Salicylates and gastric hemorrhage. II. Manifest bleeding. Gastroenterology 33: 778PubMedGoogle Scholar
  19. Langman HJS (1974) Aspirin is not a major cause of acute gastrointestinal bleeding. In: Ingelfinger FJ, Ebert RV, Finland M, Kalman AS (eds) Controversy in internal medicine, vol 2. Saunders, Philadelphia, p 493Google Scholar
  20. Levy M (1974) Aspirin use in patients with major upper gastrointestinal bleeding and pepticulcer disease. N Engl J Med 290:1158PubMedCrossRefGoogle Scholar
  21. Levy M (1980) Epidemiological evaluation of rare side-effects of mild analgesics. Br J Clin Pharmacol 10: 395SGoogle Scholar
  22. Miettinen OS (1976) Estimability and estimation in case-reference studies. Am J Epidemiol 103: 226PubMedGoogle Scholar
  23. Morgan AG, McAdam WAF, Walmsley GL, Jessop A, Norrocks JC, DeDombal FT (1977) Clinical findings, early endoscopy and multivariate analysis in patients bleeding from the upper gastrointestinal tract. Br Med J 2:237PubMedCrossRefGoogle Scholar
  24. Muir A, Cossar I (1955) Aspirin and ulcer. Br Med J 2:7PubMedCrossRefGoogle Scholar
  25. Muir A, Cossar IA (1959) Aspirin and gastric haemorrhage. Lancet 1: 539PubMedCrossRefGoogle Scholar
  26. Needham CD, Kyle J, Jones PF, Johnston SJ, Kerridge DF (1971) Aspirin and alcohol in gastrointestinal haemorrhage. Gut 12: 819PubMedCrossRefGoogle Scholar
  27. Parry DJ, Wood PHN (1967) Relationship between aspiring taking and gastrointestinal haemorrhage. Gut 8:301PubMedCrossRefGoogle Scholar
  28. Paul WD (1943) Effect of acetylsalicylic acid (aspirin) on gastric mucosa: gastroscopic study. I. Iowa M Soc 33Google Scholar
  29. Persantine-Aspirin Reinfarction Study Research Group (1980) Persantine and aspirin in coronary heart disease. Circulation 62:449Google Scholar
  30. Rees WD, Turnberg LA (1980) Reappraisal of the effects of aspirin on the stomach. Lancet 2:410PubMedCrossRefGoogle Scholar
  31. Schiller KFR, Truelove SC, Williams DG (1980) Hematemesis and melana with special reference to factors influencing the outcome. Br Med J11: 7Google Scholar
  32. Shirley E (1977) A review of papers purporting to show a cause-and-effect relationship between aspirin ingestion and massive gastrointestinal haemorrhage. Proc R Soc Med 70:4PubMedGoogle Scholar
  33. Slone D, Shapiro S, Miettinen OS (1977) Case control surveillance of serious illnesses contributable to ambulatory drug use. In: Epidemiological evaluation of drugs. Elsevier North-Holland, Amsterdam, p 59Google Scholar
  34. Valman HB, Parry DJ, Coghill NF (1968) Lesions associated with gastroduodenal haemorrhage in relation to aspirin intake. Br Med J 4: 661PubMedCrossRefGoogle Scholar
  35. Whittle BJ, Vane JR (1984) A biochemical basis for the gastrointestinal toxicity of non-steroid anti-rheumatoid drugs. Arch Toxicol [Suppl] 7: 315Google Scholar
  36. Wolf S, Wolff HG (1943) Human gastric function. Oxford University Press, LondonGoogle Scholar

Copyright information

© Springer-Verlag Berlin, Heidelberg 1987

Authors and Affiliations

  • Micha Levy
    • 1
  1. 1.Clinical Pharmacology Unit, Department of Medicine AHadassah University HospitalJerusalemIsrael

Personalised recommendations