Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Figure 2 Proton pump inhibitors and low-dose aspirin significantly exacerbate nonsteroidal anti-inflammatory drug-induced small intestinal ulceration. Rats were treated orally, twice-daily for 4.5 d with equi-effective anti-inflammatory doses of naproxen (10 mg/kg), celecoxib (10 mg/kg) or ATB-346 (14.5 mg/kg). ATB-346 is a hydrogen sulfide-releasing derivative of naproxen[38]. Starting 5 d before the nonsteroidal anti-inflammatory drugs (NSAIDs), the rats began receiving twice-daily treatments with omeprazole (Omep) (10 mg/kg) or vehicle. Starting 3 d before the NSAIDs, the rats began receiving daily doses of low-dose aspirin (10 mg/kg) or vehicle. The results are shown as the mean ± SE of at least 6 rats per group. ^aP < 0.05, ^bP < 0.01 vs the corresponding group treated with the NSAID alone. No intestinal damage was observed in rats treated with aspirin (ASA) alone. The exacerbation of small intestinal ulceration with omeprazole was also observed with another proton pump inhibitor, lanzoprazole[37]. This figure was constructed using data from Blackler et al[175].