The Epidemiological Evaluation of Major Upper Gastrointestinal Bleeding in Relation to Aspirin Use
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”.
KeywordsAplastic Anemia Acute Gastrointestinal Bleeding Habitual Intake Epidemiological Evaluation Boston Collaborative Drug Surveillance Program
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- Allan R, Dykes P (1976) A study of the factors influencing mortality rates from gastrointestinal hemorrhage. J Med 45: 533Google Scholar
- Goodman LS, Gilman A (1975) The pharmacological basis of therapeutics, 5th ed. Macmillan, New YorkGoogle Scholar
- Hurst A, Lintott GAM (1939) Aspirin as a cause of hematemesis. Guy’s Hosp Rep 89:173Google Scholar
- Katon RM, Smith FW (1983) Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding. Gastroenterology 65: 728Google Scholar
- 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
- Levy M (1980) Epidemiological evaluation of rare side-effects of mild analgesics. Br J Clin Pharmacol 10: 395SGoogle Scholar
- Paul WD (1943) Effect of acetylsalicylic acid (aspirin) on gastric mucosa: gastroscopic study. I. Iowa M Soc 33Google Scholar
- Persantine-Aspirin Reinfarction Study Research Group (1980) Persantine and aspirin in coronary heart disease. Circulation 62:449Google Scholar
- Schiller KFR, Truelove SC, Williams DG (1980) Hematemesis and melana with special reference to factors influencing the outcome. Br Med J11: 7Google Scholar
- 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
- Whittle BJ, Vane JR (1984) A biochemical basis for the gastrointestinal toxicity of non-steroid anti-rheumatoid drugs. Arch Toxicol [Suppl] 7: 315Google Scholar
- Wolf S, Wolff HG (1943) Human gastric function. Oxford University Press, LondonGoogle Scholar