Effect of Acetylsalicylic Acid on the Constituents of the Gastric Mucosal Barrier

Luminal surface hydrophobicity of canine gastric mucosa is dependent on a surface mucous gel

The contribution of the surface mucous gel to the stomach's hydrophobic luminal properties and how these properties are affected by both damaging and cytoprotective agents were studied. Canine gastric mucosa, determined to be hydrophobic in nature by contact angle analysis, had an adherent periodic acid-Schiff-reactive mucous gel layer over 85% of its luminal surface, as observed under light microscopy. Extracellular structures reactive with the phospholipid-selective stain, iodoplatinate, were observed ultrastructurally in these tissues, within and at the luminal interface of the surface mucous gel. Incubating the luminal surface of gastric mucosa mounted in Ussing chambers in acidified aspirin promoted the exfoliation of surface epithelium and markedly reduced surface hydrophobicity, surface periodic acid-Schiff reactivity, and transmucosal potential difference. Addition of 16,16-dimethyl prostaglandin E2 to the nutrient compartment of these chambers maintained surface hydrophobicity at control levels but did not prevent aspirin-induced reductions in potential difference or cellular damage to the surface epithelium. However, prostaglandin did attenuate exfoliation of aspirin-damaged surface mucous cells and preserved the surface mucous gel. These results indicate that the stomach's hydrophobic lining is closely associated with the presence of a surface mucous gel layer, is not an effective barrier to the penetration of lipid-soluble damaging agents such as acidified aspirin, and is maintained by exogenous prostaglandin as is the mucous gel layer, even in the presence of luminal aspirin. The ability of prostaglandin to maintain a hydrophobic mucous gel layer over compromised tissue may, in part, explain its ability to limit aspirin-induced injury and promote the recovery and restitution of the surface epithelium.

Enhancement of the lipid content and physical properties of gastric mucus by geranylgeranylacetone

The effects of intragastric administration of geranylgeranylacetone (GGA) on the content, composition and physical properties of the mucus component of the gastric mucosal barrier were investigated. One group of rats received twice daily for 3 consecutive days a dose of 100 mg/kg body weight of GGA, while the control group was subjected to daily doses of the vehicle. Sixteen hours following the last dose, the animals were killed, and their stomach was cut open and subjected to measurements of the adherent mucus gel content, analysis of its lipids and molecular forms of elaborated mucin, and evaluation of the viscosity and H+ retardation capacity. The results revealed that GGA elicited a 62% increase in the adherent mucus gel and caused a marked decrease in the proportion of the lower molecular weight mucin. Furthermore, the mucus of the GGA group exhibited a 67% higher content of covalently bound fatty acids and contained 46% more total lipids which were greatly (143%) enriched in phospholipids. The physical measurements demonstrated that mucus elaborated in the presence of GGA also exhibited 2.3 times higher viscosity and had a 32% greater ability to retard the diffusion of H+ than the mucus of the control group. The results suggest that GGA exerts a profound effect on the lipid content and the properties of gastric mucus associated with the maintenance of the mucosal integrity.

It is wise to prescribe NSAIDs with modern gastroprotective agents?

The administration of non-steroidal anti-inflammatory drugs (NSAIDs) leads to mucosal lesions in the upper gastrointestinal tract. Furthermore, NSAIDs increase the risk of ulcer bleeding and perforation, but the overall risk of fatal complications is relatively small (about 21 per one million prescriptions). Therefore, in asymptomatic patients, it is not justified to prescribe NSAIDs together with gastroprotective agents. The following recommendations can be given with respect to the management of peptic lesions in patients taking NSAIDs: (i) Fibre endoscopy should be performed even when there are relatively mild symptoms since mucosal lesions in rheumatic patients under NSAIDs produce minor or no symptoms. (ii) "Modern" NSAIDs might produce less gastric lesions than aspirin. (iii) Rheumatic patients with peptic disorders should be treated with an H2-antagonist. (iv) After complications such as ulcer bleeding or after rapid recurrence of peptic lesions, maintenance treatment with an H2-antagonist is advisable.

Effect of acetylsalicylic acid on gastric mucin viscosity, permeability to hydrogen ion, and susceptibility to pepsin

The effect of acetylsalicylic acid (aspirin) on peptic degradation of gastric mucin, its viscosity and the ability to retard the diffusion of hydrogen ion was investigated. The results of peptic degradation indicated that, in the absence of the drug, the rate of proteolysis was proportional to mucin concentration up to 400 micrograms and remained constant with time for up to 1 hr. Introduction of aspirin led to an enhancement in the rate of proteolysis. The apparent Km value of pepsin toward mucus glycoprotein was 8.7 X 10(-7) M in the absence of the drug and 6.9 X 10(-7) M in its presence. Viscosity measurements showed a drop in mucin viscosity following preincubation with aspirin. This decrease was concentration dependent and at a 4.0 X 10(-5) M concentration of the drug reached a value of 75%. Permeability studies revealed that preincubation with 2.0 X 10(-5) M aspirin increased the permeability of mucin to hydrogen ion by 10%, while an 18% increase was obtained with 4.0 X 10(-5) M aspirin. The results suggest that aspirin weakens the integrity of the gastric mucus layer by promoting its peptic degradation, decreasing viscosity, and reducing the ability to resist hydrogen ion penetration.

Gastric protection by sucralfate. Role of mucus and prostaglandins

Sucralfate promotes the healing of peptic ulcers and, in large doses, increases gastric mucosal prostaglandins. The present study was designed to further elucidate the protective effect of sucralfate and to evaluate the role of prostaglandins in this action. Eight chair-adapted rhesus monkeys received a subcutaneous injection of either 150 mg/kg of aspirin or vehicle in combination with either a therapeutic oral dose of sucralfate (50 mg/kg X day) or water. Gastric soluble mucus concentration was determined in samples of gastric juice by Alcian blue dye binding of acidic glycoproteins, and mucus output was determined using a technetium 99m-diethylenetriaminepentaacetic acid dilution technique. Monkeys underwent endoscopy to assess gastric mucosal damage, which was ranked blindly on a scale of 0-5, and to obtain biopsy specimens for determination of mucosal prostaglandin E2, prostaglandin F2 alpha, and 6-keto-prostaglandin F1 alpha. Aspirin did not alter soluble mucus but did significantly increase gastric mucosal damage and suppress tissue levels of all prostaglandins. Sucralfate significantly increased the output of soluble mucus, even after aspirin treatment, and protected against aspirin-induced damage, although it did not modify aspirin-induced suppression of prostaglandins. These results suggest that the gastric protection afforded by sucralfate is related to a prostaglandin-independent increase in mucus production.