Introduction and historical aspects of the side-effects of anti-inflammatory analgesic drugs. In: Rainsford KD, Velo GP, editors. Side-Effects of Anti-Inflammatory Drugs. Dordrecht: Springer Netherlands; 1987. pp. 3-26. [DOI: 10.1007/978-94-010-9772-7_1]

Effects of colloidal bismuth subcitrate on aspirin-induced gastric microbleeding, DNA loss, and prostaglandin formation in humans

Ten healthy young male subjects took part in a double-blind, placebo-controlled, crossover trial to assess the effect of colloidal bismuth subcitrate (De-No) on prostaglandin (PG) E2 generation and mucosal integrity in an aspirin (ASA)-treated stomach. After administration of ASA (2.5 g) plus placebo, a marked reduction in mucosal generation of PGE2 (by about 85%) was observed, and this was accompanied by a significant increase in gastric microbleeding and DNA loss and endoscopic and histologic damage of the mucosa. After the combination of De-Nol (300 mg four times daily) with ASA, mucosal generation of PGE2 showed a reduction similar to that in tests with ASA plus placebo, but gastric microbleeding and mucosal damage were significantly reduced. It is concluded that De-Nol has a protective action on ASA-induced gastric microbleeding and that this protection occurs despite a marked suppression of mucosal production of prostaglandins.

Gastrointestinal damage from nonsteroidal anti-inflammatory drugs

The mechanisms underlying the development of gastrointestinal (GI) damage by the NSAIDs differ considerably from drug to drug. Aside from environmental or intersubject influence (e.g., concurrent disease, physical or sociopsychologic stress, dietary and genetic status), the intrinsic pharmacokinetic and physicochemical differences in these drugs account for variations in their rate of absorption or uptake from the circulation into the GI mucosa. Differences in the preference for absorption in the different regions of the GI tract account for the propensity of these drugs to cause injury in those regions wherein they accumulate. Bacterial flora and food antigens may be particularly important in promoting injury in the lower intestinal tract, whereas in the sterile environment of the normal stomach these may have less significance (except in achlorhydric states). The multiple cellular actions of NSAIDs are reviewed and the consequences of inhibiting prostaglandin cyclo-oxygenase considered. Under some conditions, the excess production of vasoconstrictor leukotrienes/HETES relative to effects of cyclo-oxygenase inhibition is postulated to have particularly important consequences in the pathogenesis of mucosal injury by NSAIDs. These consequences are separate from the concept of prostaglandin deficiency previously suggested by others.