Misoprostol Heals Small Bowel Ulcers in Aspirin Users With Small Bowel Bleeding

Kyaw, Moe H.; Otani, Koji; Ching, Jessica; Higashimori, Akira; Kee, Ka Man; Watanabe, Toshio; Tse, Yee Kit; Lee, Vivian; Tanigawa, Tetsuya; Cheong, Pui Kuan; Suen, Bing Yee; Fujiwara, Yasuhiro; Lam, Kelvin; Chan, Francis K.L.

doi:10.1053/j.gastro.2018.06.056

Cited by 28 publications

(20 citation statements)

References 23 publications

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“…Furthermore, it is unclear whether patients in this study continued aspirin or NSAIDs during the ulcer healing period. More recently, Kyaw et al reported that misoprostol was superior to the placebo in the promoting healing of small-bowel ulcers and improving anemia among LDA users complicated by small-bowel ulcer bleeding with a complete ulcer healing rate of the misoprostol group and placebo group being 28.6% and 9.5%, respectively [101]. This is the first randomized study on the treatment of small-bowel bleeding while continuing LDA.…”

Section: Misoprostolmentioning

confidence: 86%

Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review

2019

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Recent advances in small-bowel endoscopy such as capsule endoscopy have shown that non-steroidal antiinflammatory drugs (NSAIDs) frequently damage the small intestine, with the prevalence rate of mucosal breaks of around 50% in chronic users. A significant proportion of patients with NSAIDs-induced enteropathy are asymptomatic, but some patients develop symptomatic or complicated ulcers that need therapeutic intervention. Both inhibition of prostaglandins due to the inhibition of cyclooxygenases and mitochondrial dysfunction secondary to the topical effect of NSAIDs play a crucial role in the early process of injury. As a result, the intestinal barrier function is impaired, which allows enterobacteria to invade the mucosa. Gram-negative bacteria and endogenous molecules coordinate to trigger inflammatory cascades via Toll-like receptor 4 to induce excessive expression of cytokines such as tumor necrosis factor-a and to activate NLRP3 inflammasome, a multiprotein complex that processes pro-interleukin-1b into its mature form. Finally, neutrophils accumulate in the mucosa, resulting in intestinal ulceration. Currently, misoprostol is the only drug that has a proven beneficial effect on bleeding small intestinal ulcers induced by NSAIDs or low-dose aspirin, but its protection is insufficient. Therefore, the efficacy of the combination of misoprostol with other drugs, especially those targeting the innate immune system, should be assessed in the next step. Keywords Non-steroidal anti-inflammatory drug Á Lowdose aspirin Á Enteropathy Á Innate immunity Á Misoprostol Abbreviations NSAID Non-steroidal anti-inflammatory drug RA Rheumatoid arthritis

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Section: Misoprostolmentioning

confidence: 86%

Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review

2019

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“…A pilot RCTs by Fujimori et al, 20 involving 34 healthy volunteers, showed that misoprostol (200 µg given 3 times daily) co-therapy reduced the incidence of smallintestinal mucosal breaks induced by a 2-week administration of diclofenac sodium. Recently, Kyaw et al 21 performed an RCT of 84 aspirin users with small bowel bleeding who required aspirin therapy and found that misoprostol (200 µg given 4 times daily) for 8 weeks was superior to placebo in healing of small bowel ulcers. Similar results were also reported in another randomized trial by Taha et al 22 Though the potential protective effects of misoprostol were observed in these studies, large clinical trials with long-term outcomes are lacking.…”

Section: Misoprostolmentioning

confidence: 99%

Potential Strategies in the Prevention of Nonsteroidal Anti-inflammatory Drugs-Associated Adverse Effects in the Lower Gastrointestinal Tract

Guo

Leung

2020

Gut and Liver

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With the increasing use of nonsteroidal anti-inflammatory drugs (NSAIDs), the incidence of lower gastrointestinal (GI) complications is expected to increase. However, unlike upper GI complications, the burden, pathogenesis, prevention and treatment of NSAID-associated lower GI complications remain unclear. To date, no cost-effective and safe protective agent has been developed that can completely prevent or treat NSAID-related lower GI injuries. Selective COX-2 inhibitors, misoprostol, intestinal microbiota modulation, and some mucoprotective agents have been reported to show protective effects on NSAID-induced lower GI injuries. This review aims to provide an overview of the current evidence on the prevention of NSAID-related lower GI injuries. (Gut Liver 2020;14:179-189)

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“…Previously, there was no strategy to prevent NSAID-induced enteropathy [13,44]. However, a recent study reported the effectiveness of misoprostol in the treatment of SB ulcer bleeding associated with aspirin [45]. On the contrary, lesions that induce stenosis, which may not be treated with medication alone, require endoscopic or surgical interventions [46].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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

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Misoprostol Heals Small Bowel Ulcers in Aspirin Users With Small Bowel Bleeding

Cited by 28 publications

References 23 publications

Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review

Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review

Potential Strategies in the Prevention of Nonsteroidal Anti-inflammatory Drugs-Associated Adverse Effects in the Lower Gastrointestinal Tract

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

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