Associations between drugs and small‐bowel mucosal bleeding: Multicenter capsule‐endoscopy study

Niikura, Ryota; Yamada, Atsuo; Maki, Koutarou; Nakamura, Masanao; Watabe, Hirotsugu; Fujishiro, Mitsuhiro; Oka, Shiro; Esaki, Motohiro; Fujimori, Shunji; Nakajima, Atsushi; Ohmiya, Naoki; Matsumoto, Takayuki; Tanaka, Shinji; Koike, Kazuhiko; Sakamoto, Choitsu

doi:10.1111/den.12922

Cited by 20 publications

(15 citation statements)

References 31 publications

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“…SBCE can visualize the entire small‐intestinal mucosa and facilitate visualization of small‐intestinal abnormalities. Several studies have confirmed the efficacy of SBCE for certain disorders, such as small‐bowel (SB) bleeding, suspected and diagnosed Crohn's disease (CD), SB malignant tumors, and small‐intestinal mucosal injury associated with use of non‐steroidal anti‐inflammatory drugs …”

Section: Introductionmentioning

confidence: 99%

“…Several studies have confirmed the efficacy of SBCE for certain disorders, such as small-bowel (SB) bleeding, suspected and diagnosed Crohn's disease (CD), SB malignant tumors, and small-intestinal mucosal injury associated with use of non-steroidal anti-inflammatory drugs. 2 Since SBCE's introduction, there has been progress of not only SBCE devices (e.g. wider field of view, analytical software) but also regimens of the SBCE procedure (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Capsule endoscopy for small‐intestinal disorders: Current status

Hosoe

Takabayashi

Ogata

et al. 2019

Digestive Endoscopy

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Small‐bowel capsule endoscopy (SBCE) is used widely because of its non‐invasive and patient‐friendly nature. SBCE can visualize entire small‐intestinal mucosa and facilitate detection of small‐intestinal abnormalities. In this review article, we focus on the current status of SBCE. Several platforms for SBCE are available worldwide. Third‐generation SBCE (PillCam® SB3) has a high‐resolution camera equipped with an adaptive frame rate system. Several software modes have been developed to reduce the reading time for capsule endoscopy and to minimize the possibility of missing lesions. The main complication of SBCE is capsule retention. Thus, the main contraindication for SBCE is known or suspected gastrointestinal obstruction unless intestinal patency is proven. Possible indications for SBCE are obscure gastrointestinal bleeding, Crohn's disease, small‐intestinal polyps and tumors, and celiac disease. Colon capsule endoscopy (CCE) can observe inflamed colonic mucosa non‐invasively, and allows for the continuous and non‐invasive observation of the entire intestinal tract (pan‐endoscopy). Recently, application of CCE as pan‐enteric endoscopy for inflammatory bowel diseases (including Crohn's disease) has been reported. In the near future, reading for CE will be assisted by artificial intelligence, and reading CE videos for long periods will not be required.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Capsule endoscopy for small‐intestinal disorders: Current status

Hosoe

Takabayashi

Ogata

et al. 2019

Digestive Endoscopy

View full text Add to dashboard Cite

show abstract

“…Furthermore, the impact of capsule endoscopy on clinical outcomes remains controversial despite reports of SB mucosal damage in 70% of patients taking NSAIDs, 22,40 because it remains unclear whether SB mucosal injuries contribute to signi cant bleeding. 41 Although patients with NSAID-induced SB injury show low frequency of severe bleeding in the SB, 42 rebleeding rates of 21-35% have been reported in patients with SB ulcerations during a mean follow-up period of 17.1-29.7 months. 15,43 These reports suggest a clinical implication of SB ulcers, which cannot be ignored.…”

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding: A retrospective study

Lim

Jung

Lee

et al. 2020

Preprint

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Background: Small bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Although angioectasia is the common etiology of SB bleeding, nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are also reported as a major cause in studies from Eastern countries. Herein, we assessed the frequency of occurrence of NSAID-induced SB lesions in Korean patients with obscure GI bleeding. Methods: We retrospectively analyzed medical records of all consecutive patients aged ≥18 years who underwent capsule endoscopy from March 2018 to February 2019 at Ulsan University Hospital and Kosin University Gospel Hospital. Results: Of the 83 subjects (all Korean; mean age ± standard deviation: 59 ± 18 years; age range: 18–84 years; men: n=52; women: n=31), 55 (66.2%) had stool with clear blood and 28 (33.8%) had normal stool with iron deficiency anemia. The detection rate of SB bleeding and lesions using capsule endoscopy was 72.3% (60 of 83 patients). A significantly higher frequency (40 of 51) of ulcerative/erosive lesions than other causes was observed in patients with inactive bleeding but visible SB lesions. As a result, NSAID-induced enteropathy accounted for 30.1% of 83 patients with obscure GI bleeding (25 of the all 60 SB bleeding cases).Conclusions: Contrary to what is reported for patients in Western countries, this study in Korean patients showed an improved diagnostic yield of capsule endoscopy for obscure GI bleeding and that NSAID-induced enteropathy was the most common etiology of SB bleeding. Aggressive small intestine examination is required for patients with unexplained GI bleeding.

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“…Furthermore, the impact of capsule endoscopy on clinical outcomes remains controversial despite reports of SB mucosal damage in 70% of patients taking NSAIDs, 22,39 because it remains unclear whether SB mucosal injuries contribute to significant bleeding. 40 Although patients with NSAIDinduced SB injury show low frequency of severe bleeding in the SB, 41 rebleeding rates of 21-35% have been reported in patients with SB ulcerations during a mean follow-up period of 17.1-29.7 months. 15,42 These reports suggest a clinical implication of SB ulcers, which cannot be ignored.…”

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding

Lim

Jung

Lee

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Small bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Although angioectasia is the common etiology of SB bleeding, nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are also reported as a major cause in studies from Eastern countries. Herein, we assessed the frequency of occurrence of NSAID-induced SB lesions in Korean patients with obscure GI bleeding.Methods: We retrospectively analyzed medical records of all consecutive patients aged ≥18 years that underwent capsule endoscopy from March 2018 to February 2019 at Ulsan University Hospital and Kosin University Gospel Hospital.Results: Of the 83 subjects (all were Korean; mean age ± standard deviation: 59 ± 18 years; age range: 18–84 years; men: n=52; women: n=31), 55 (66.2%) had stools with clear blood and 28 (33.8%) had normal stools with iron deficiency anemia . The detection rate of SB bleeding and lesions using capsule endoscopy was 72.3% (60 of 83 patients). A significantly higher frequency (40 of 51) of ulcerative/erosive lesions than other causes was observed in patients with inactive bleeding but visible SB lesions. As a result, NSAID-induced enteropathy accounted for 41.7% (25 of 60) of all SB bleeding cases.Conclusions: Contrary to what is reported for patients in Western countries, this study in Korean patients showed an improved diagnostic yield of capsule endoscopy for obscure GI bleeding and that NSAID-induced enteropathy was the most common etiology of SB bleeding. Aggressive small intestine examination is required for patients with unexplained GI bleeding.

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Associations between drugs and small‐bowel mucosal bleeding: Multicenter capsule‐endoscopy study

Cited by 20 publications

References 31 publications

Capsule endoscopy for small‐intestinal disorders: Current status

Capsule endoscopy for small‐intestinal disorders: Current status

Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding: A retrospective study

Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding

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