Prevalence of Gastric and Small-Intestinal Mucosal Injury in Elderly Patients Taking Enteric-Coated Aspirin by Magnetically Controlled Capsule Endoscopy

Abstract

Objective To investigate aspirin-related gastric and small-intestinal mucosal injury in elderly patients by magnetically controlled capsule endoscopy (MCCE). Methods Patients taking enteric-coated aspirin attending the outpatient department of Beijing Anzhen Hospital, Capital Medical University, from September 2017 to July 2019 underwent MCCE to assess injury to the gastric and small-intestinal mucosa. The patients were divided into the elderly group (age ≥ 60 years) and middle-aged group (45 years ≤ age < 60 years), and their clinical data were evaluated. Results Sixty-eight patients (34 per group) taking enteric-coated aspirin were recruited, and the elderly and middle-aged groups did not differ significantly in sex, history of smoking, history of alcohol consumption, body mass index, or accompanying diseases. In the elderly and middle-aged groups, the gastric Lanza scores were 2.0 (2.0, 3.0) and 2.0 (1.0, 3.0; P = 0.192), the numbers of patients with small-intestinal mucosal injuries (at least one erosion and/or ulcer) were 30 (88.2%) and 15 (44.1%; P < 0.001), the numbers of patients with more severe small-intestinal mucosal injuries (larger erosion and/or ulcer) were 11 (32.4%) and 3 (8.8%; P = 0.033), the numbers of patients with ileal erosion were 22 (64.7%) and 8 (23.5%; P = 0.001), and the durations of aspirin use were 30.0 (12.0, 120.0) and 10.5 (2.0–48.0) months (P = 0.007), respectively. Conclusions The rate of small-intestinal mucosal injury was significantly higher in elderly than in middle-aged patients taking enteric-coated aspirin, especially the rate of ileal erosion. MCCE enables the monitoring of aspirin-related gastric and small-intestinal mucosal injury in elderly patients, which can guide treatment decision making.

Enteric-Coated Aspirin and the Risk of Gastrointestinal Side Effects: A Systematic Review

“… 20 , 21 Additionally, the degree of this small bowel mucosal injury was greater in elderly patients taking ECA than middle-aged patients. 10 In another case control study, the risk of upper GI complications was similar for both ECA and non-ECA. So, the authors concluded that the coating did not adjust the effect of aspirin.…”

“…The mechanisms by which aspirin causes GI mucosal damage are thought to be by both direct topical injury on the epithelium and mainly, a systemic effect associated to prostaglandin depletion. 9 , 10 Different research has mentioned the risk factors for aspirin-induced GI complications, such as higher aspirin dose, advanced age, history of peptic ulcer disease, use of combinations of non-steroidal anti-inflammatory drugs and concomitant use of drugs such as steroids or anticoagulants. 11 , 12 …”

Development and Application of Magnetically Controlled Capsule Endoscopy in Detecting Gastric Lesions

“…The preliminary results show that MCCG is of considerable benefit to the elderly and is generally safe. Another study by Gao et al [40] shows that MCCG can monitor aspirin-related gastric mucosal lesions in elderly patients and guide treatment decisions. In 2018, a clinical study in Ruijin Hospital Affiliated to Shanghai Jiaotong University recruited 84 minor patients hospitalized in the pediatric department who underwent MCCG examinations, with an average age of 12 ± 3:2 years.…”

Antithrombotic therapy in the elderly and senile age: the consensus opinion of experts of the Russian Association of Gerontologists and Geriatricians and the National Society of Preventive Cardiology

“…развитию ЖКК всегда предшествует повреждение слизистой оболочки ЖКТ. При помощи капсульной эндоскопии было установлено, что повреждающее воздействие антитромботических препаратов не ограничивается слизистой верхнего отдела ЖКТ, а распространяется также и на нижний от-дел, затрагивая тонкий и толстый кишечник [182,[185][186][187]. В последние годы наблюдается тенденция к снижению частоты ЖКК из верхнего отдела ЖКТ и, соответственно, увеличению -из нижнего отдела ЖКТ, связанная отчасти с более высокой распространённостью дивертикулов толстого кишечника и ангиодисплазии в пожилом возрасте.…”