NSAIDs, aspirin, and esophageal strictures - Are over-the-counter medications harmful to the esophagus?

There are several studies that suggest that aspirin (acetylsalicylic acid [ ASA]) and nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with esophagitis or esophageal stricture formation. Then are limited data on th e potential of low-dose ASA and over-the-counter (OTC) NSAIDs to cause esop hageal injury. The goal of this study was to determine whether there is an association between esophageal strictures and ASA/NSAID use, including low- dose ASA and OTC NSAIDs. A total of 79 consecutive patients (mean age, 52.8 years; 38 men, 41 women) referred for endoscopy from 4/1/96 to 11/15/96 fo r chronic gastroesophageal reflux disease symptoms were evaluated. Data col lected include gender, race, and age, NSAID or ASA use, as well as an asses sment of dysphagia, heartburn duration, and heartburn frequency. Patients t aking NSAIDs or ASA at least twice a week were considered ASA/NSAID users. There were 46 patients without strictures and 33 patients with peptic stric tures. Patients with strictures were older than patients without strictures (mean age, 58.7 versus 48.6 years; p < 0.01), had longer duration of heart burn symptoms (8.6 versus 6.4 years, p < 0.05), and were mon likely to have mucosal injury (50% versus 26.1%). Stricture patients were more likely to use ASA/NSAIDs (63.6% versus 26.1%: p < 0.01). In particular, stricture pat ients were more likely to use low-dose ASA than patients without strictures (30.3% versus 2.2% p < 0.01). Otherwise, there were no significant differe nces with regard to gender, race, or heartburn duration or frequency. Linea r regression analysis showed that ASA/NSAID use had a greater influence on the incidence of peptic strictures than age. There is an association betwee n esophageal stricture and ASA/NSAID use, which includes OTC NSAIDs and low -dose ASA.