Is there a significant difference between enteric and nonenteric aspirin?
—Janne M. Huynh, MD, Bronx, N.Y.

Aspirin and other nonsteroidal anti-inflammatory drugs can cause significant gastroduodenal toxicity resulting from both local and systemic effects, the latter due to cyclooxygenase (COX) inhibition, with a resultant decrease in mucosal-protective gastric prostaglandins. Various strategies have been employed to limit these adverse effects, including the use of enteric coating. As a carboxylic-acid derivative, aspirin is not ionized in the acidic environment of the stomach and readily absorbs across the gastric mucosa where it then ionizes and can lead to local epithelial damage. Enteric coating delays this absorption until after the aspirin has passed beyond the stomach—in theory limiting direct gastroduodenal irritation.

While it is true that enteric-coated aspirin reduces endoscopic signs of gastroduodenal injury (Clin Ther. 1993;15:314-320), there does not appear to be any clinically relevant impact on the risk of bleeding (Lancet. 1996;348:1413-1416). Thus, the benefit of enteric coated aspirin is debatable.
—Daniel G. Tobin, MD (103-2)

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