Factors predicting the presence of small bowel lesions in patients with obscure gastrointestinal bleeding

Shimizu, Eiji; Endo, Hideki; Taniguchi, Leo; Hata, Yasuo; Ezuka, Akiko; Nagase, Hajime; Yamada, Eiji; Ohkubo, Hidenori; Higurashi, Takuma; Sekino, Yusuke; Koide, Tomoko; Iida, Hiroshi; Hosono, Kunihiro; Nonaka, Takashi; Takahashi, Hirokazu; Inamori, Masahiko; Maeda, Shin; Nakajima, Atsushi

doi:10.1111/den.12002

Cited by 35 publications

(39 citation statements)

References 38 publications

(81 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There might be a difference in the pharmacological severity causing mucosal injury between NSAIDs and LDA. However, previous studies have shown that LDA frequently caused mucosal injury in the small intestine [18]. Based on the present results, we could not elucidate the reason for this discrepancy.…”

Section: Discussioncontrasting

confidence: 93%

“…On the basis of the above evidence, related risk factors for OGIB have also been indicated: increasing age [15,16], the presence of comorbidities (connective tissue disease, chronic kidney disease, and chronic liver disease, etc.) [15,17,18], and history of medication usage [low-dose aspirin (LDA), non-steroidal anti-inflammatory drugs (NSAIDs), and anti-thrombotic drugs] [15,19]. However, these reports mainly show the findings indicated by examination with CE alone.…”

Section: Introductionmentioning

confidence: 99%

“…In clinical cases, we have often found that endoscopic manifestations of intestinal bleeding detected by BAE are different from those detected by CE examination. Furthermore, there are some reports indicating that risk factors related to OGIB are different in occult and overt OGIB cases with erosion/ulcer versus angiodysplasia/vascular lesions in the small intestine [10,18]. Meanwhile, recent reports have shown the direct effects of LDA and NSAIDs on mucosal injuries and the possibly protective effects of misoprostol and rebamipide on LDAand NSAID-induced mucosal injuries in the small intestine [20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Risk Factors Between Small Intestinal Ulcerative and Vascular Lesions in Occult Versus Overt Obscure Gastrointestinal Bleeding

et al. 2015

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Risk Factors Between Small Intestinal Ulcerative and Vascular Lesions in Occult Versus Overt Obscure Gastrointestinal Bleeding

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The frequency of positive CE findings is reported to be higher in patients with overt OGIB than in those with occult OGIB (59.5 vs. 46.2%, respectively; p = 0.03) [6]. The other related risk factors are the presence of chronic renal failure, a history of non-steroidal anti-inflammatory drug (NSAID) and low-dose aspirin (LDA) use, and proton pump inhibitor use [7]. Angioectasia is associated with the pathogenesis of liver cirrhosis, chronic renal failure treated with hemodialysis, and heart valve syndrome.…”

Section: Utility Of Ce In Ogibmentioning

confidence: 99%

Clinical Utility of Capsule Endoscopy and Double-Balloon Enteroscopy in the Management of Obscure Gastrointestinal Bleeding

et al. 2018

View full text Add to dashboard Cite

Background: Obscure gastrointestinal bleeding (OGIB) is a common but embarrassing problem for gastroenterologists. Most bleeding lesions associated with OGIB are present in the small intestine and sometimes cannot be identified due to the difficulty associated with physical accessibility. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have enabled in the process of diagnosing and have evolved to become approaches to treating OGIB. Summary: CE is a minimally invasive procedure and has a high diagnostic yield in patients with OGIB. DBE offers additional advantage of biopsy collection for pathological diagnosis and therapeutic intervention, but it should be noted that it sometimes causes severe adverse events such as acute pancreatitis, intestinal bleeding, and intestinal perforation. CE should be performed early in the workup course of OGIB. Positive CE findings enhance the diagnostic yield of subsequent DBE, and the effective therapeutic intervention improves the clinical outcomes of OGIB patients. On the contrary, there are no clear guidelines for further investigation of patients with negative CE findings at the present. Although patients in stable general condition may only require follow-up, repeated CE is useful to detect positive findings in patients with evidence of sustained bleeding and progressing anemia. We have revealed that repeated CE has higher positive finding rate than DBE in OGIB patients with negative CE findings in a preliminary study. Key Messages: CE and DBE have complementary roles in the management of OGIB, and the precise timing and proper sequence may be important for the approach to treating OGIB.

show abstract

“…In the clinical studies, while Goldstein et al [3] confirmed the ineffectiveness of omeprazole for protection from NSAID-induced intestinal damage in healthy volunteers, other studies reported that suppression of gastric acid secretion itself was analyzed as a risk factor for the severity or bleeding of small intestinal lesions [54,55]. …”

Section: Ppi Therapy: Potential Of Exacerbating Intestinal Lesionsmentioning

confidence: 99%

Current Topics of Strategy of NSAID-Induced Small Intestinal Lesions

et al. 2015

View full text Add to dashboard Cite

Small intestinal mucosal injuries have been recently recognized as common complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) because video capsule endoscopy and balloon enteroscopy are now available for the detection of small intestinal lesions. Small intestinal injury occurs not in an acid-dependent mechanism but by various factors such as enteric bacteria, bile acids, prostaglandin (PG) deficiency and topical factors (abnormal intestinal mucosal permeability, mitochondrial dysfunction, reactive oxygen species, endoplasmic reticulum stress and so on), and there is no well-established prophylactic approach. Several experimental and clinical studies found the effectiveness of some of the mucoprotective drugs, PG analogs, but not that of acid suppressants. Considering the effect of proton pump inhibitors (PPIs) for upper gastrointestinal (GI) disease and in the small intestine, the following 2 kinds of strategies against NSAID-induced GI injuries may be recommended. In patients with a high risk of upper GI disease (peptic ulcer etc.), simultaneous administration of a PPI (for upper GI disease) and a mucoprotective drug (for small intestine) is needed to prevent NSAID-induced GI injury. In other cases, an effective mucoprotective drug is enough for the protection of the entire digestive tract, that is, starting from the esophagus to the small intestine. These strategies may fulfill both economical and curative effects.

show abstract

Factors predicting the presence of small bowel lesions in patients with obscure gastrointestinal bleeding

Abstract: Our results indicated that bleeding pattern and clinical characteristics could contribute to predicting the origin of OGIB.

Cited by 35 publications

References 38 publications

Comparison of Risk Factors Between Small Intestinal Ulcerative and Vascular Lesions in Occult Versus Overt Obscure Gastrointestinal Bleeding

Comparison of Risk Factors Between Small Intestinal Ulcerative and Vascular Lesions in Occult Versus Overt Obscure Gastrointestinal Bleeding

Clinical Utility of Capsule Endoscopy and Double-Balloon Enteroscopy in the Management of Obscure Gastrointestinal Bleeding

Current Topics of Strategy of NSAID-Induced Small Intestinal Lesions

Contact Info

Product

Resources

About