The Problem of Aspirin-Induced Gastrointestinal Tract Lesions in Patients with Stable Ischemic Heart Disease Receiving Acetylsalicylic Acid

Abstract

Erosive and ulcerative lesions of the gastrointestinal (GI) tract are common in patients with cardiovascular diseases, particularly those with ischemic heart disease (IHD). Numerous studies demonstrate that acetylsalicylic acid (ASA), widely used for secondary prevention of cardiovascular events, significantly increases the risk of mucosal injury throughout the GI tract. Gastric and duodenal erosions occur in up to 63% of patients, while ulceration and bleeding may develop in up to 40% and 7.7% of cases, respectively. These complications are strongly associated with patient age, concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, corticosteroids, Helicobacter pylori infection, and arterial hypertension. ASA-related enteropathy, although less studied, manifests in up to 71% of long-term users and may lead to anemia, protein loss, or intestinal obstruction. Importantly, a significant proportion of patients remain asymptomatic until complications such as bleeding arise. Despite the widespread use of gastroprotective therapy, no universal preventive strategy has been established to fully mitigate ASA-induced enteropathy or colopathy. The findings highlight the need for individualized risk assessment and close endoscopic monitoring in patients with IHD receiving long-term ASA therapy.