Evidence for a Sex-linked Difference in Aspirin Metabolism

Abstract

ASPIRIN is the most widely consumed drug on Earth. Although adverse reactions to its use are relatively rare, they are nevertheless clinically common because of the universal use of this “everyman's medicine”. These complications may present as hypersensitivity reactions such as asthma and rhinorrhoea, but most often they take the form of gastric erosions and/or ulcerations with mucosal bleeding. The relative rarity of gastric complications of aspirin ingestion suggests that they occur only in individuals who, for one reason or another, are at greater risk or in circumstances, such as the prior abuse of alcohol, which favour their development. Several studies conducted in Australia provide an important clue to the identification of a population at risk from ingestion of aspirin. In 1963 Billington^1,2 reported that the incidence of chronic gastric ulcer in women began to increase after 1943 in New South Wales, something which had not occurred in Australian men. Billington theorized that the factor responsible for this change in the epidemiology of peptic ulcer disease in that part of the world was extraneous and probably behavioural. Then, Chapman and Duggan reported a significant association between gastric ulceration in young women of New South Wales and the regular use of compounds containing aspirin^3,4. They found no such association with gastric ulceration in males or with duodenal ulceration in either sex. Other Australian authors have confirmed the existence of an association between chronic usage of aspirin and gastric ulceration^5,6. These well controlled clinical studies suggest that women who consume ASA regularly are at a greater risk of developing gastric complications than are men.