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Could a Probiotic Reduce Aspirin-Induced Intestinal Damage?

1/21/2020 3:17:46 PM
small intestineMore than 30% of the US population over the age of 40 is estimated to take daily, low-dose aspirin (acetylsalicylic acid or ASA) for cardiovascular prevention. However, the chronic intake of a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, is associated with damage to the gastric and small intestinal mucosa—contributing to lesions, ulcers, perforations, or hemorrhage. 

Studies examine protective role of probiotics

Previous research has focused more on the gastric damage from NSAID use than the intestinal damage, yet the pathogenesis is different. Whereas acid and pepsin are involved in gastric damage, bile and bacteria are the factors more likely to influence small-intestinal injury. Hence, researchers conducted a randomized, double-blind, placebo-controlled trial to determine whether supplementation with a single bacterial strain of Bifidobacterium breve (Bif195) could reduce the risk of intestinal damage induced by daily intake of ASA.
At a clinical research center in Ireland, 75 healthy volunteers between the ages of 18 and 40 participated in the trial. Participants were randomly assigned to take a placebo or Bif195 (5 x 1010 colony-forming units per day) for 8 weeks. All participants also took 300 mg of ASA per day for the first 6 weeks.
Video capsule endoscopy, a widely accepted reference standard for occult gastrointestinal bleeding, was used to assess intestinal damage. Small intestinal mucosal damage was categorized by the Lewis score, which is a validated tool to evaluate villous edema, ulcers, stenosis, and small bowel inflammation. The primary outcomes were the areas under the curve (AUCs) for Lewis score and number of ulcers.

Results show probiotics may reduce GI risk

The results showed a gradual increase in mucosal damage during the 6 weeks of daily ASA intake and partial reversal toward baseline over the 2-week recovery period. The ASA-induced damage was primarily localized to the duodenum. The major finding of this study was that the AUCs for both the Lewis score and ulcer number were significantly lower in the Bif195 arm than the placebo arm, the primary endpoint of this study (Pvalue = .0376).
Importantly, the protective effect of Bif195 against intestinal damage did not interfere with the cardiovascular-protective effects of ASA. In participants taking Bif195, ASA still inhibited the cyclo-oxygenase (COX) enzyme and reduced its downstream products.
This study was conducted for only 8 weeks, whereas many people take ASA for years. Still, the results reveal new possibilities for the use of specific probiotic strains to reduce the risk of side effects from ASA.
Mortensen, B, C Murphy, J O’Grady, M Lucey, G Elsafi, L Barry, V Westphal, A Wellejus, O Lukjancenko, AC Eklund, HB Nielsen, A Baker, A Damholt, JET van Hylckama Vlieg, F Shanahan, and M Buckley. “Bifidobacteriumbreve Bif195 Protects Against Small-Intestinal Damage Caused By Acetylsalicylic Acid in Healthy Volunteers.” Gastroenterology 157, no. 3 (2019): 637–646.e4.