Effects of Combined Treatment with Aspirin and Diclofenac or Indomethacin on the Gastric Mucosa of the Rat (Reduced Damage by Proton Pump Inhibitors)

Objectives: To investigate the gastric mucosal injury caused by the combined treatment of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) and to identify the optimum methods to avoid such injury. Methods: Sixty albino Wistar rats of 200-250gm were used in this study. The animals were divided into 8 groups. Group I served as control and received the vehicle of the used drugs (aspirin, diclofenac and indomethacin). Groups II, III, and IV received single daily dose of aspirin (4mg/kg body weight), diclofenac (2mg/kg. body weight) and indomethacin (2mg/kg body weight) respectively. Group V received aspirin and diclofenac and Group VI received aspirin and indomethacin as above. Group VII and VIII received omeprazole (2mg/kg body weight) one hour befor ingestion of aspirin and diclofenac or aspirin and indomethacin as above. At the end of treatment, lesions in the stomach were evaluated macroscopically and microscopically. Results: Macroscopic analysis showed that treatment with aspirin, diclofenac and indomethacin separately induced multiple gastric mucosal lesions which were larger and deeper following the combined treatment of aspirin and either diclofenac or indomethacin. Microscopically the lesions include increased mucous production, oedema, congestion, necrosis and hemorrhage of the fundic mucosa. After the administration of omeprazole (proton pump inhibitor) most of the mucosal lesions show evidence of partial healing. Conclusion: Combined treatment with aspirin and diclofenac or indomethacin produced larger and deeper gastric fundic mucosal lesion than aspirin treatment alone. Omeprazole ingestion added to the above drugs significantly healed lesions compared to the control group by 75% and 70% (p=0.05).