Low-Dose Aspirin Affects the Small Bowel Mucosa: Results of a Pilot Study With a Multidimensional Assessment

Smecuol, Edgardo; Sánchez, María Inés Pinto; Suarez, Alejandro L.; Argonz, Julio; Sugai, Emilia; Vázquez, Horacio; Litwin, Néstor; Piazuelo, Elena; Meddings, Jonathan B.; Bai, Julio C.; Lanas, Ángel

doi:10.1016/j.cgh.2008.12.019

Cited by 101 publications

(72 citation statements)

References 24 publications

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“…Our results indicated that the incidence of small intestinal mucosal injury tended to be lower in Hp-infected patients than in non-Hp-infected patients. Because aspirin or NSAIDs inhibit cyclooxygenase (COX) and prostaglandin (PG) production at inflamed sites and may increase the risk of mucosal damage in the small intestine [18,19], the incidence of enteritis was determined in patients not receiving aspirin/NSAIDs; the results of this evaluation revealed that the rate of enteritis was significantly lower in the Hp-infected patients than in the Hp-noninfected patients. These findings suggest that H. pylori infection might protect the small intestinal mucosa against injury.…”

Section: Discussionmentioning

confidence: 99%

Influence of Helicobacter pylori Infection on the Small Intestinal Mucosa

2013

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patients undergoing capsule endoscopy (CE) were tested for anti-H. pylori immunoglobulin G antibody (Hp-IgG) using an enzyme-linked immunosorbent assay (ELISA). None of the patients had been treated for H. pylori infection or diagnosed as having Crohn's disease or any other clinically apparent small intestinal disorders prior to the CE. Results. The overall Hp-IgG-positive rate was 26.3%. The incidence of enteritis, as diagnosed by CE, tended to be lower in the Hp-IgG-positive patients (23.1%) than in the Hp-IgG-negative patients (38.4%) ( = 0.140). When patients receiving aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), well-known causes of enteritis, were excluded, the incidence of enteritis in the Hp-IgG-positive patients (11.7%) was significantly lower than that in the Hp-IgG-negative patients (43.7%) ( = 0.005). A binomial logistic regression analysis revealed a significant negative relationship between Hp-IgG positivity and the presence of enteritis in patients receiving neither aspirin nor NSAIDs ( = 0.017). Conclusions. Our data indicated that H. pylori positivity was inversely associated with the prevalence of enteritis.

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Section: Discussionmentioning

confidence: 99%

Influence of Helicobacter pylori Infection on the Small Intestinal Mucosa

2013

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“…Using CE, several studies have been reported. Post-lowdose aspirin CE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers) [9]. After 2 weeks of low-dose aspirin, the percentages of subjects with small bowel pathology were 80% in the aspirin group compared with 20% in the control group (p=0.023) [10].…”

Section: Introductionmentioning

confidence: 94%

Non-Steroidal Anti-Inflammatory Drug (NSAID)-Induced Small Intestinal Injury

Tajima¹

2013

Pharm Anal Acta

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“…Although we intended to record any NSAID consumption, we have considered NSAIDs consumers only those patients who had received even a single dose of NSAIDs the week preceded WCE study. Continuous NSAIDs consumption (both aspirin and non-aspirin) for up to 2 wk was recorded as short term, while longer-term use was considered long-term [1,7,8] .…”

Section: Patients-datamentioning

confidence: 99%

“…The later could be accessed by either double-balloon [6] or capsule endoscopy (WCE) [1] . WCE identified small bowel mucosal damage (mucosal breaks, reddened folds, petechiae and denuded mucosa) in 50%-70% of healthy volunteers after a short course of NSAIDs and even more lesions in chronic NSAID consumers [1,7,8] . On the contrary mucosal damage was present only in 10% of subjects not exposed to NSAIDs [1] .…”

Section: Introductionmentioning

confidence: 99%

Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

Tsibouris

Kalantzis

Apostolopoulos

et al. 2014

WJGE

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AIM:To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS:In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration (cases) and 60 matched patients with a non-bleeding peptic ulcer (controls) underwent small bowel capsule endoscopy, after a negative colonoscopy (compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowel lesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present.Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy. RESULTS:Forty (67%) cases and 18 (30%) controls presented small bowel erosions (P = 0.0001), while 22 (37%) cases and 4 (8%) controls presented small bowel ulcers (P < 0.0001). Among non-steroidal antiinflammatory drug (NSAID) consumers, 39 (95%) cases and 17 (33%) controls presented small bowel erosions (P < 0.0001), while 22 (55%) cases and 4 (10%) controls presented small bowel ulcers (P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3 (SD = 1.4) g/dL in cases with small bowel ulcerative lesions and 10.5 (SD = 1.3) g/dL in those without (P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6 (27%) cases with small bowel ulcers presented bleeding recurrence most possibly attributed to small bowel ulcers, nevertheless 30-d mortality was zero. Presence of chronic obstructive lung disease and diabetes was related with unexplained recurrence of hemorrhage in logistic regression analysis, while absence of small bowel ulcers was protective (relative risk 0.13, P = 0.05). CONCLUSION:Among NSAID consumers, more bleeders than non-bleeders with peptic ulcers present small bowel ulcers; lesions related to more severe bleeding and unexplained episodes of bleeding recurrence.© 2014 Baishideng Publishing Group Inc. All rights reserved. PROSPECTIVE STUDY

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Low-Dose Aspirin Affects the Small Bowel Mucosa: Results of a Pilot Study With a Multidimensional Assessment

Cited by 101 publications

References 24 publications

Influence of Helicobacter pylori Infection on the Small Intestinal Mucosa

Influence of Helicobacter pylori Infection on the Small Intestinal Mucosa

Non-Steroidal Anti-Inflammatory Drug (NSAID)-Induced Small Intestinal Injury

Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

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