Enteric-coated aspirin bezoar: elevation of serum salicylate level by barium study. Case report and review of medical management

Abstract

The gastric accumulation of enteric-coated aspirin tablets due to peptic ulcer disease or gastric outlet scarring and the impaired gastric emptying that results have been previously reported. In the case reported herein, an unanticipated peaking of plasma salicylate levels occurred following radiographic studies in which barium was used. This phenomenon prompted an in vitro study in which dissolution rates of enteric-coated aspirin in various barium preparations were determined, suggesting that dissolution is dependent upon effervescent activity of the milieu, as well as pH. The use of barium in diagnosing suspected accumulation of enteric-coated aspirin is discussed, and techniques for tablet removal are reviewed.