Gastrointestinal blood loss. Effect of aspirin, fenoprofen, and acetaminophen in rheumatoid arthritis as determined by sequential gastroscopy and radioactive fecal markers

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Abstract
The feasibility of determining the exact site and amount of drug-induced gastric bleeding was tested. Patients (14) with rheumatoid arthritis received equivalent therapeutic doses of the antiinflammatory drugs aspirin, 4 g/day, and fenoprofen calcium, 2.4 g/day, in randomized order for 7 days. Acetaminophen was given for 14 days just prior to each of these periods. By fiberoptic gastroscopy, antral ulceration and acute mucosal lesions were found in 7 patients following aspirin ingestion, in 1 taking fenoprofen, and in none taking acetaminophen. Fecal blood loss in 4 day stool collections, quantitated by autologous 51Cr labeled erythrocytes shed into the stool averaged 5.0 ml/day while taking aspirin, 2.2 ml/day while taking fenoprofen calcium and 0.8 ml/day while taking acetaminophen. The mean blood loss was greater for those in whom gastric lesions developed while taking aspirin than for those in whom lesions did not develop. The short-term risk of erosive gastritis was greater for aspirin than fenoprofen.

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