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

Abstract

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”.