Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy

Nagata, Naoyoshi; Niikura, Ryota; Aoki, Tomonori; Shimbo, Takuro; Kishida, Yoshihiro; Sekine, Katsunori; Tanaka, Shohei; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Akiyama, Junichi; Yanase, Mikio; Mizokami, Masashi; Uemura, Naomi

doi:10.1016/j.gie.2014.06.039

Cited by 52 publications

(50 citation statements)

References 35 publications

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“…In LG, colonic DH was the most common disorder causing LGIB. Moreover, colonic DH has also recently been reported as the most common cause of LGIB in Japan [2,12] . Compared to a few decades ago, changes in the agingassociated diseases that cause LGIB have been occurring.…”

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 96%

“…widely used for risk reduction and secondary prevention of cerebral and cardiovascular events in Japan, based on 20022009 guidelines from the American College of Cardiology and American Heart Association [10,11] . ATDs and NSAIDs have been reported as risk factors for LGIB [2,3] . These background factors, together with the aging of the population, are thought to be key reasons for the rapid increase in the incidence of LGIB.…”

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 99%

“…In the United States, endoscopy is recommended "in the early evaluation of severe acute LGIB" [1] . Use of oral antithrombotic drugs (ATDs) and non steroidal anti-inflammatory drugs (NSAIDs) is increasing with the aging of the population, and the number of patients with diseases causing LGIB is increasing [2,3] . In addition, the types of diseases being encountered are also changing.…”

Section: Introductionmentioning

confidence: 99%

“…DH is also increasing in Japan. In fact, diverticular hemorrhage (DH) is now one of the most common causes of LGIB in Japan and Western countries [2,3,6] . The present study examined changes over time in diseases causing LGIB that are associated with aging.…”

Section: Introductionmentioning

confidence: 99%

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Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

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AIM:To classify changes over time in causes of lower gastrointestinal bleeding (LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage (DH). METHODS:A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group (EG, 1995(EG, -2006 n = 828) and a late group (LG, 2007(LG, -2013 Author contributions: Kinjo K collected and analyzed the data, and drafted the manuscript; Matsui T designed and supervised the study; Washio M performed the statistical analysisl; Hisabe T, Ishihara H, Maki S, Chuman K, Koga A, Ohtsu K, Takatsu N, Hirai F and Yao K performed the colonoscopy and revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.Institutional review board statement: This study was approved by the institutional review board of Fukuoka University Chikushi Hospital (R15-024) and was conducted in accordance with the Declaration of Helsinki.Informed consent statement: In this study, We do not necessarily need the individual agreement from a study subject. Because this study is retrospective study and based on the ethical guidelines for medical studies intended for people "taken from the human body undergoes No. 12 informed consent procedures was used samples not research". Information about the implementation of this research exposes to Fukuoka University Chikushi Hospital clinical research support Center home page. Conflict-of-interest statement:In connection with this manuscript, there is no Conflict of Interest to be disclosed with any companies.Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at matsui@ fukuoka-u.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low. Retrospective Studybetween patients with and without DH. RESULTS:Older patients (≥ 70 years old) and those with colonic DH were more frequent in LG than in EG (P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity (body mass index ≥ 25 kg/m 2 ), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION:Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients. Core tip: Colonic diverticular hemorrhage (DH) is the most frequent cause of lower gastrointestinal bleeding. A rapid increase in the incidence of colonic DH has been seen with the aging population. One reason is the widespread adoption of antithrombotic drugs (ATDs) since the early 2000s, based on guidelines to prevent ischemic heart disease and ischemic cerebrovascular disease. DH is more likely in patients who are older, are men, obesity, use nonsteroidal anti-inf...

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Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 96%

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

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“…In lower gastrointestinal bleeding, a synergetic effect has been reported between NSAIDs and other drugs. 30 In upper gastrointestinal bleeding, a Japanese guideline and another meta-analysis reported that the risk of peptic ulcer complications increases when NSAIDs are given with steroids or anticoagulants. 2,31 We confirmed this effect in relation to small-bowel overt bleeding.…”

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confidence: 99%

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

Niikura

Yamada

Maki

et al. 2017

Digestive Endoscopy

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Background and Aim: Although several drugs may induce small-bowel mucosal injuries, it is unclear whether these injuries contribute to overt small-bowel bleeding. This study was designed to evaluate the associations between drug use and small-bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease-relevant population. Methods:We retrospectively studied patients with suspected small-bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small-bowel mucosal injury and small-bowel overt bleeding.Results: In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small-bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01-3.31) was significantly associated with an increased risk of small-bowel mucosal injury compared with non-use. Patients with small-bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders. Conclusion:Although the use of NSAIDs was significantly associated with an increased risk of small-bowel mucosal injury, no significant associations were observed between the use of such drugs and small-bowel overt bleeding.

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