Prevention of nonsteroidal anti-inflammatory drug–induced small-intestinal injury by prostaglandin: a pilot randomized controlled trial evaluated by capsule endoscopy

Fujimori, Shunji; Seo, Tsuguhiko; Gudis, Katya; Ehara, Akihito; Kobayashi, Tsuyoshi; Mitsui, Keigo; Yonezawa, Masaoki; Tanaka, Shu; Tatsuguchi, Atsushi; Sakamoto, Choitsu

doi:10.1016/j.gie.2008.08.017

Cited by 124 publications

(110 citation statements)

References 24 publications

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“…When the subjects received a placebo, there were significantly more mucosal injuries in the small intestine, such as erosions and ulcers, compared to when they received rebamipide. Misoprostol co-therapy also reduced the incidence of small-intestinal lesions induced by a 2-week administration of diclofenac sodium in healthy subjects [70].…”

Section: Prevention and Treatment Of Small Intestinal Mucosal Injury mentioning

confidence: 85%

Present status and strategy of NSAIDs-induced small bowel injury

et al. 2009

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Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to cause gastroduodenal mucosal lesions as an adverse effect. Recently, the serious problem of NSAID-induced small intestinal damage has become a topic of great interest to gastroenterologists, since capsule endoscopy and balloon enteroscopy are available for the detection of small intestinal lesions. Such lesions have been of great concern in clinical settings, and their treatment and prevention must be devised as soon as possible. The prevalence of NSAIDs-induced small intestinal injury is higher than had been expected. Recent studies show that more than 50% of patients taking NSAIDs have some mucosal damage in the small intestine. The gross appearance of NSAIDinduced enteropathy varies, appearing variously as diaphragm-like strictures, ulcers, erosions, and mucosal redness. To investigate NSAID-induced enteropathy, and to rule out other specific enteropathies, other useful methods (in addition to capsule endoscopy and balloon enteroscopy) include such modalities as radiological examination of the small intestine, the permeability test, scintigraphy or the fecal excretion test using 111 Indium-labeled white blood cells, and measurement of the fecal calprotectin concentration. Diaphragm-like strictures and bleeding from mucosal breaks may be treatable with interventional enteroscopy. Misoprostol, metronidazole, and sulfasalazine are frequently used to treat NSAID-induced enteropathy, but have undesirable effects in some cases. In the experimental model, we confirmed that several existing drugs for gastroduodenal ulcers prevented indomethacin-induced small intestinal injury. Such drugs may be useful for preventing the adverse effects of NSAIDs not only in the stomach but also in the small intestine. We hope to examine these drugs in future clinical studies.

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Section: Prevention and Treatment Of Small Intestinal Mucosal Injury mentioning

confidence: 85%

Present status and strategy of NSAIDs-induced small bowel injury

et al. 2009

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“…Furthermore, mucosal breaks were classified into erosions or ulcers on the basis of the sizes of the small bowel mucosal breaks, because by definition, an ulcer requires some degree of penetration (through the muscularis mucosa), and the angle of the images obtained by the capsule is often such that it is impossible to evaluate the depth of the lesions [2,4]. Reddened lesions were defined as reddish mucosal changes such as reddened folds, denuded areas, and petechiae, all grouped into a single classification as reddened lesions [10].…”

Section: Discussionmentioning

confidence: 99%

“…Fujimori et al reported that use of misoprostol, a prostaglandin analogue, prevented in healthy subjects with diclofenac-induced small intestinal injuries [4]. Niwa et al reported that taking rebamipide, an endothelial prostaglandin inducer, prevented in healthy subjects with diclofenac-induced small intestinal injuries compared with placebo [5].…”

Section: Introductionmentioning

confidence: 99%

A randomized, double-blinded, placebo-controlled, multicenter trial, healing effect of rebamipide in patients with low-dose aspirin and/or non-steroidal anti-inflammatory drug induced small bowel injury

et al. 2013

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Background: It is not clear what kind of drug is appropriate to heal forNSAIDs-induced enteropathy. Several reports showed the preventive effect of prostaglandin analogue or inducer using healthy subjects who took NSAIDs. However there was no report for healing effect and for patients. The aim of this study was to evaluate the healing effect of rebamipide in patients with NSAIDs-induced enteropathy.In addition, we evaluated for nutritional parameter. Methods: This study was conducted as a randomized, double-blinded, placebo-controlled, multicenter trial. Study protocol was approved by each hospital's ethical committees. Patients with LDA and/or NSAID more than 3 month were enrolled.Patients with enteropathy were divided into the placebo and the rebamipide groups.Rebamipide 100mg three times daily was administered during 4 weeks. Capsule endoscopies were performed at 0 and 4 week. The number of small intestinal ulcer and erosion were evaluated. Total protein was analyzed as nutritional parameters.

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“…Characteristically, one may find erythema, erosions, minute ulcerations and classically web like strictures can be seen (18). Likewise, SBCE can monitor the effectiveness of drugs to protect against small bowel NSAIDS injury (19), to evaluate the mucosa of transplant patients, and in graft versus host disease (GVHD) (20,21).…”

Section: Monitoring Drug Effects or Side Effectsmentioning

confidence: 99%

Where do I see minimally invasive endoscopy in 2020: clock is ticking

Eliakim

2017

Ann. Transl. Med.

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Since it was introduced 17 years ago, capsule endoscopy has become an important diagnostic tool for the small bowel. Three generations of the original small bowel capsule have been developed since (PillCam SB3, Medtronic, USA), and four competitors were introduced for the small bowel. A non-video patency capsule (Agile patency capsule, Medtronic, USA) was also developed, in order to confirm patency and thus avoid retention in the GI tract. Moreover, capsules viewing other organs of the body (esophagus, colon) as well as three different magnetic guided capsules that visualize the stomach as good as optical endoscopy (OE) have been developed. Over 2,000 articles looking at the efficacy of the small bowel capsule in different clinical situations were published since then.Studies are comparing capsule endoscopy versus other modalities in various indications, looking at preparations aiming to improve the diagnostic yield and at technical aspects. The present paper, describes the available capsules in the market and my biased future expectations.Keywords: Small bowel capsule endoscopy (SBCE); colon capsule endoscopy (CCE); magnetic capsule endoscopy (MCE); optical endoscopy (OE)

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Prevention of nonsteroidal anti-inflammatory drug–induced small-intestinal injury by prostaglandin: a pilot randomized controlled trial evaluated by capsule endoscopy

Cited by 124 publications

References 24 publications

Present status and strategy of NSAIDs-induced small bowel injury

Present status and strategy of NSAIDs-induced small bowel injury

A randomized, double-blinded, placebo-controlled, multicenter trial, healing effect of rebamipide in patients with low-dose aspirin and/or non-steroidal anti-inflammatory drug induced small bowel injury

Where do I see minimally invasive endoscopy in 2020: clock is ticking

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