A Small Bowel Ulcer due to Clopidogrel with Cytomegalovirus Enteritis Diagnosed by Capsule and Double-Balloon Endoscopy

Ebi, Masahide; Inoue, Satoshi; Sugiyama, Tomoya; Yamamoto, Kazuhide; Adachi, Kazunori; Yoshimine, Takashi; Yamaguchi, Yoshiharu; Tamura, Yasuhiro; Izawa, Shinya; Hijikata, Yasutaka; Funaki, Yasushi; Ogasawara, Nagahisa; Sasaki, Makoto; Kasugai, Kunio

doi:10.1159/000490096

Cited by 2 publications

(1 citation statement)

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“…It became possible to examine the small intestine through as double balloon endoscopy and capsule endoscopy[ 8 , 9 ].According to previous studies, the incidence of small bowel ulcers and bleeding due to NSAIDs was about eight times higher than that of patients who did not take NSAIDs[ 10 ]. Low-dose aspirin has been reported to cause small bowel injury and 57.6% of the chronic users had mucosal breaks[ 11 ]. The crude risk of GI events in patients taking no antiplatelet therapy was 1.6%.…”

Section: Discussionmentioning

confidence: 99%

Small bowel ulcer bleeding due to suspected clopidogrel use in a patient with clopidogrel resistance: A case report

Lee¹,

Ryu²,

Lee³

et al. 2021

WJCC

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BACKGROUND Clopidogrel is a platelet aggregation inhibitor used for the management of cardiovascular disease. While antiplatelet therapy decreases cardiovascular events after successful coronary drug-eluting stenting, it increases the risk of gastrointestinal (GI) bleeding. About 20% of the patients who take clopidogrel exhibit resistance to the drug. CASE SUMMARY We report the first case of a small bowel bleeding ulcer in an 86-year-old man with clopidogrel resistance. He had a history of taking clopidogrel due to unstable angina. There was no evidence of bleeding in the stomach, duodenum, or colon through upper and lower GI endoscopies. The abdominal computed tomography showed the extravasation of radiocontrast media at the ileum. Because of unstable vital signs, emergency surgery was performed. Multiple ulcers with inflammation were found in the ileum. The pathologic findings revealed simple inflammation. The VerifyNow P2Y12 test showed clopidogrel resistance. One year after changing to aspirin, capsule endoscopy was performed and the small bowel ulcers were improved. CONCLUSION Small bowel ulcers and bleeding due to clopidogrel are not very common, but the prevalence is expected to increase in older age patients with risk factors despite clopidogrel resistance.

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