11 replies to this topic

[ta5]

I want to take low-dose aspirin. I can't because it gives me heartburn (not an ulcer). Apparently aspirin can relax the esophageal sphincter in some people, including me. I tried ecotrin-coated baby aspirin, and it still gives me heartburn.

 

Is there another form of aspirin, or something else with similar benefits, that would not have this side effect?

 

Thanks.

[Ritchie]

Have you tried taking an antacid with aspirin like baking soda?
What effects are you looking for from aspirin? Only esophageal sphincter relaxation? Or also anti-inflammatory action?

[ta5]

Thanks, but baking soda won't help very much. For me, the problem isn't acid production exactly. The problem is that it relaxes the esophageal sphincter. That's what causes the reflux. An antacid might make that less severe, but it's still going to be bad. I have to avoid the reflux in the first place.

 

The positive effects I'm looking for are all of them. And, actually I'm not looking for "something else with similar benefits". I really want the same benefits. Like if there's another NSAID that would have the same mode of action but not cause reflux, that would be great.

[Ritchie]

I have found 20 chemicals with identical mechanisms of action to aspirin here: http://www.ncbi.nlm....Result=68000894

But are you sure you want something which works by mechanisms identical to aspirin, as I imagine these would have identical side effects as well. If your interested in an anti-inflammatory with different effects than aspirin. Have a look at Hyperforin. It's the main alkaloid in saint johns wort and has potent anti-inflammatory action, 3-18 times more potent than aspirin.

[Raza]

I had the same problem, and found some study saying that matching your aspirin dose with vitamin C prevented most gastrointestinal side effects. I crushed my tablets and mixed them with sodium ascorbate, which I take as a powder with water. No problems since.

 

Frankly, 'enteric coated capsules' and other coating mechanisms seem to make stomach problems worse, not better, for drugs that cause them. The only result is that the coating will give at one location first, and you get a highly concentrated and lengthy flow of the dissolved substance from that point only. Much better to dissolve the whole load in water before swallowing it, so the concentration is distributed and doesn't get overly high at any single point on the stomach wall.

[ta5]

Thanks Raza. That's interesting.

 

Do you take it on an empty stomach? Not with food?

 

 

Do you think it's important to use sodium ascorbate? Do you think calcium ascorbate would be ok?

[Jeoshua]

From what mechanisms he's describing, Calcium Ascorbate would be ideal, since Calcium has pretty good effects on stomach issues, as well. It's the Vitamin C he's recommending, not the Sodium. Although, you did mention antacids having no real effect, so the difference would be minimal.

[ta5]

Zinc-L-Carnosine (PepZin Gl) may be helpful. If it is, it might only help prevent an ulcer and not GERD. So, it may not help me, but it may help others.

 

 

 

Dig Dis Sci. 2001 Apr;46(4):845-51.

Effects of polaprezinc on lipid peroxidation, neutrophil accumulation, and TNF-alpha expression in rats with aspirin-induced gastric mucosal injury.

Naito Y1, Yoshikawa T, Yagi N, Matsuyama K, Yoshida N, Seto K, Yoneta T.

We examined the roles of lipid peroxidation, neutrophil accumulation, and inflammatory cytokines in the protective effect of polaprezinc against aspirin-induced gastric mucosal injury in rats. The intragastric administration of acidified aspirin induced hyperemia and hemorrhagic erosions in rat stomachs. The increase in the total gastric erosive area after aspirin administration was significantly inhibited in a dose-dependent manner by treatment with polaprezinc. The increases in thiobarbituric acid-reactive substances and tissue-associated myeloperoxidase activity 3 hr after aspirin administration were significantly inhibited by pretreatment with polaprezinc. The gastric concentration of TNF-alpha increased after aspirin administration, and the increase was also inhibited in a dose-dependent manner by treatment with polaprezinc. The peak expression of TNF-alpha mRNA 1 hr after aspirin administration was inhibited by 30 mg/kg of polaprezinc. Based on these data, the beneficial effects of polaprezinc on aspirin-induced gastric mucosal injury may be attributed to its antioxidative and antiinflammatory properties.

PMID: 11330422

 

 

BMC Gastroenterol. 2013 Jul 4;13:108.

Effectiveness of polaprezinc for low-dose aspirin-induced small-bowel mucosal injuries as evaluated by capsule endoscopy: a pilot randomized controlled study.

Watari I1, Oka S, Tanaka S, Aoyama T, Imagawa H, Shishido T, Yoshida S, Chayama K.

BACKGROUND:

Treatment of low-dose aspirin (LDA)-induced small-bowel injury has not been established. Polaprezinc, a chelate of zinc and L-carnosine, may be efficacious for such injury. We conducted a pilot randomized controlled study to investigate whether polaprezinc is effective against LDA-induced small-bowel injuries.

METHODS:

Consecutive patients under long-term (>3 months) LDA treatment and who agreed to participate in our study underwent initial capsule endoscopy (CE). Patients with LDA-induced small-bowel injury apparent upon initial CE (n = 20) were randomized into a polaprezinc (150 mg/day for 4 weeks) group and a control (no polaprezinc treatment) group. All underwent follow-up CE after 4 weeks. Changes in the number and characteristics of small-bowel mucosal injuries were compared within and between the two groups.

RESULTS:

The median number of reddened lesions and erosions/ulcers upon follow-up CE in the polaprezinc group significantly decreased (P < 0.05). However, there was no significant difference in the median number of reddened lesions and erosions/ulcers upon follow-up CE in the control group.

CONCLUSIONS:

Co-administration of polaprezinc may be effective against small-bowel mucosal injury associated with long-term LDA therapy.

PMID: 23826914

 

 

 

This one shows it was not effective in dogs:

 

J Vet Intern Med. 2011 Jan-Feb;25(1):39-46.

Effects of zinc-L-carnosine and vitamin E on aspirin-induced gastroduodenal injury in dogs.

Baan M1, Sherding RG, Johnson SE.

BACKGROUND:

Nonsteroidal anti-inflammatory drugs frequently cause gastrointestinal (GI) injury. Zinc-L-carnosine has antioxidant, anti-inflammatory, mucosal protective, and healing properties in rodent models and in some human studies of GI injury.

HYPOTHESIS:

The combination of zinc-L-carnosine and vitamin E attenuates aspirin-induced gastroduodenal mucosal injury.

ANIMALS:

Eighteen healthy random-source Foxhound dogs.

METHODS:

In this randomized, double-blinded, placebo-controlled study dogs were treated with placebo (n = 6; 0X group), 30 mg/30 IU (n = 6; 1X group), or 60 mg/60 IU (n = 6; 2X group) zinc-L-carnosine/vitamin E orally every 12 hours for 35 days. Between Day 7 and 35, GI mucosal lesions were induced with aspirin (25 mg/kg p.o. q8h). Mucosal injury lesions (hemorrhage, erosion, and ulcer) were assessed by gastroduodenoscopy on Days 14, 21, and 35 with a 12-point scoring scale.

RESULTS:

At baseline (Day -1) gastroscopy scores were not significantly different between groups (mean ± SD: 0X, 4.4 ± 0.8; group 1X, 4.4 ± 0.6; group 2X, 4.2 ± 0.3; P= .55). Gastroscopy scores increased significantly in all groups between Day -1 and Days 14, 21, and 35 (P < .0001). On Day 35, gastroscopy scores were 29.2 ± 5.2 (0X), 27.3 ± 3.7 (1X), and 28.6 ± 3.3 (2X). Mean gastroscopy scores were not significantly different among treatment groups on any of the days (P = .61).

CONCLUSIONS AND CLINICAL IMPORTANCE:

Administration of the combination of zinc-L-carnosine and vitamin E at 1X or 2X dosing did not attenuate aspirin-induced gastroduodenal mucosal injury.

PMID: 21092006 

 

 

[ta5]

I wonder if D-Limonene would help?

 

From an Alt Med Rev article: (Amazingly, the altmedrev.com domain name expired! Oops. Full text is here.)

 

In a double-blind, placebo-controlled study, 13 participants suffering from mild/moderate to severe heartburn/GERD were randomized to d-limonene or placebo. Seven participants in the d-limonene group received 1,000 mg d-limonene once daily or every other day, while six participants received an identical capsule containing soybean oil (placebo). Each participant was asked to rate the frequency and severity of symptoms on a scale of 1-10 described above. On day four, 29 percent of participants in the d-limonene group experienced significant relief of symptoms (severity rating=1-2), compared to no relief of symptoms in the placebo group. By day 14, 86 percent of participants achieved complete relief of symptoms, compared to 29 percent of participants in the placebo group.19

 

Results from these two studies suggest the beneficial effects of d-limonene appear to develop over time, with the best results attained after following a 10-capsule regimen. The mechanisms of actions of d-limonene have not been fully elucidated. In vitro study suggests it may neutralize the effect of gastric acid by coating the stomach wall and protecting the mucosal lining from gastric acid exposure.19

 

19. Wilkins J Jr. Method for treating gastrointestinal disorder. U.S. Patent (642045). 2002.

 

 

[maxwatt]

Salsalate is a non-gastric irritating drug that doesn't cause gastric bleeding. Prescription only. It converts to salicilate in the blood stream, and does cause the same amount of systemic bleeding from capillaries. Formerly much used for arthritis, now fallen in disfavour.

Enteric coated aspirin may be an option, thoug low dose enteric aspirin is not made. You could make your own by costing a baby aspirin with an edible food wax such as carnuba.

Edited by maxwatt, 01 June 2014 - 09:57 PM.

[PWAIN]

Sorry but I'm pretty sure that my baby aspirin say they are enteric coated.

[ta5]

Thanks maxwatt. I'd like to try Salsalate. Does anyone know an international pharmacy that sells it? I checked unitedpharmacies, inhouse, and alldaychemist.

 

Also, I wonder why it has fallen in disfavor?