A daily dose of aspirin may help your heart. But as with other nonsteroidal anti-inflammatory drugs (NSAIDs), these widely used analgesics and anti-inflammatories may not be as kind to your gut. Mucosal lesions, ulcers, perforations, and hemorrhage may occur but the extent is unknown.
Notably however, the stomach and bowel may need different prevention strategies. Suppressing acid can offset harms to the stomach. But unfortunately, the proton pump inhibitors often used may actually disturb the small bowel microbiota leading to intestinal injury.
Causes of these small bowel damages by NSAIDs are coming to light:
- Microbiota composition changes
- Aspirin (Acetylsalicylic Acid) compromises the phospholipid layer in mucus, increasing access to luminal aggressors like lipopolysaccharide and bile, as well as disrupting intestinal permeability and causing inflammation.
- Underlying this is evidence showing that giving NSAIDs to germ-free animals causes minimal damage to the small-intestinal mucosa.
Bifidobacterium Protection Research
New research has hypothesized that anti-inflammatory bacteria (probiotics) may offer protection against ulceration in NSAID users. Bifidobacterium breve Bif195 Protects against Small-Intestinal Damage Caused by Acetylsalicylic Acid in Healthy Volunteers appeared in Gastroenterology Journal in May 2019.
In this study, 75 healthy volunteers were randomly assigned to groups given oral capsules of Bifidobacterium breve or placebo daily for 8 weeks. Serial video capsule endoscopy was used to assess small-intestinal damage in healthy volunteers exposed to acetylsalicylic acid at 6 visits.
Twelve adverse events were reported from the Bifidobacteria group and 20 from the placebo group, none of which were related to probiotic intake.
The trial results indicate that the Bifidobacteria breve strain conferred significant protection against small-intestinal damage caused by a 6-week aspirin challenge in healthy volunteers.
The dose used in this study was 300mg daily, higher than the 81mg dose usually taken for heart protection. Nevertheless, it is suggested that probiotics may shield from some of the intestinal downsides.