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Reactive Increase in Gastric Mucus Secretion Is an Adaptive Defense Mechanism Against Low-Dose Aspirin-Induced Gastropathy

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Abstract

Background

Gastric mucus is considered to play an essential role in gastric mucosal defense mechanisms, especially when irritants are present in the stomach.

Aim

To investigate the relationship between low-dose aspirin-induced gastropathy and gastric secretory function, especially gastric mucus secretion, in healthy volunteers.

Methods

Thirty male, asymptomatic, Helicobacter pylori pylori-negative healthy volunteers were asked to take 100 mg of enteric-coated aspirin (Bayaspirin) once a day for 10 days. Endoscopic examination was performed before and 3 and 10 days after drug administration. The extent of endoscopically assessed gastric mucosal injury was semi-quantitatively evaluated according to the modified Lanza score. The pentagastrin-stimulated gastric juice was collected for 10 min during the endoscopic examination and subjected to analysis for gastric acid (mEq/10 min) or mucus (mg hexose/10 min) output.

Results

Overall, the 10-day aspirin treatment significantly increased gastric mucus secretion from 0.8 (interquartile range 1.7) to 1.6 (1.6) mg hexose/10 min (P < 0.05), with a concomitant and significant decrease in the gastric acid/mucus ratio from 4.3 (5.2) to 2.9 (4.7) (P < 0.01). Subsequent analysis of two subgroups of volunteers categorized according to their endoscopic status (“severe gastropathy” vs. “modest gastropathy”) revealed that changes in gastric secretory parameters occurred exclusively in those subjects without severe gastric injury; there was no alteration in these parameters in subjects with severe gastric injury.

Conclusions

The results of this study suggest that the reactive increase in gastric mucus secretion is an adaptive defense mechanism against low-dose aspirin-induced gastropathy. In some individuals, such a response may be insufficient to prevent the development of severe mucosal injury and even ulcers and their complications.

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Abbreviations

COX:

Cyclooxygenase

EGT:

Endoscopic gastrin test

GSRS:

Gastro-intestinal symptom rating scale

LDA:

Low-dose aspirin

MLS:

Modified Lanza score

NSAID:

Non-steroidal anti-inflammatory drug

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Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan

    K. Iijima, T. Iwabuchi, N. Ara, T. Koike, H. Shinkai & T. Shimosegawa

  2. Department of Pathological Biochemistry, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan

    Y. Kamata & T. Ichikawa

  3. Kitasato Junior College of Health and Hygienic Sciences, Niigata, Japan

    K. Ishihara

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  1. K. Iijima
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  2. T. Iwabuchi
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Correspondence to K. Iijima.

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Iijima, K., Iwabuchi, T., Ara, N. et al. Reactive Increase in Gastric Mucus Secretion Is an Adaptive Defense Mechanism Against Low-Dose Aspirin-Induced Gastropathy. Dig Dis Sci 58, 2266–2274 (2013). https://doi.org/10.1007/s10620-013-2660-7

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