Small Bowel Injury by Low-Dose Enteric-Coated Aspirin and Treatment With Misoprostol: A Pilot Study

Watanabe, Toshio; Sugimori, Satoshi; Kameda, Natsuhiko; Machida, Hirohisa; Okazaki, Hirotoshi; Tanigawa, Tetsuya; Watanabe, Kenji; Tominaga, Kazunari; Fujiwara, Yasuhiro; Oshitani, Nobuhide; Higuchi, Kazuhide; Arakawa, Tetsuo

doi:10.1016/j.cgh.2008.06.021

Cited by 153 publications

(151 citation statements)

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“…Aspirin seems to be less harmful to the small intestine than NSAIDs. In 2008, Watanabe et al [15] examined 11 gastric ulcer patients who were taking low-dose aspirin. They used VCE to examine whether or not small-intestinal lesions were present.…”

Section: Present Status Of Small Intestinal Mucosal Injury Caused By mentioning

confidence: 99%

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: Present Status Of Small Intestinal Mucosal Injury Caused By mentioning

confidence: 99%

Present status and strategy of NSAIDs-induced small bowel injury

et al. 2009

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“…Энтеропатия бы-ла диагностирована в 100 % случаев. Прием мизопростола 200 мкг 4 раза в день в течение 8 нед оказался эффективен при лечении индуцированной АСК энтеропатии [48]. Помимо аналогов про-стагландинов разрабатываются и апробируются другие химиче-ские соединения с цитопротективной активностью в тонкой киш-ке (Rebamipide, Teprenone, Polaprezinc, Irsogladine maleate), но по-ка они доступны только в нескольких азиатских странах [49][50][51].…”

Section: терапевтический архив 12 2014unclassified

Antiplatelet therapy with acetylsalicylic acid: Approaches to reducing the frequency of gastrointenstinal adverse reactions

Ev¹

2014

Ter. arkh.

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Антитромбоцитарная терапия (АТТ) ингибитором синтеза тромбоксана А 2 -ацетилсалициловой кислотой (АСК) -высоко эффективна для профилактики сердечно-сосудистых осложне-ний (ССО). Между тем снижение риска развития кардиологиче-ских событий достигается путем повышения вероятности неже-лательных реакций со стороны органов пищеварения.Прием АСК традиционно связывают с поражением прокси-мальных отделов (ПО) желудочно-кишечного тракта (ЖКТ). При длительной терапии низкими дозами АСК частота развития симптомов диспепсии достигает 15-40% [1], эрозивного эзофа-гита -7,9-22%, язв пищевода -0,9% [2,3], эрозий желудка и/ или двенадцатиперстной кишки (ДПК) -34-63,1% [4,5], язв желудка и/или ДПК -10-40% [6]. Относительный риск (ОР) желудочно-кишечных кровотечений (ЖКК) варьирует, по расче-там различных авторов, в пределах от 2,4 до 7,7 [7,8]. Показатель выше в случаях приема АСК для первичной по сравнению с вто-ричной профилактикой ССО [9].Между тем благодаря внедрению в клиническую практику новых методов диагностики появились сведения о поражении АСК дистальных отделов (ДО) пищеварительного тракта. Назна-чение АСК в дозе 100 мг/сут здоровым добровольцам привело через 2 нед к повреждению слизистой оболочки (СО) тонкой АннотацияПрием ацетилсалициловой кислоты (АСК) высокоэффективен для профилактики сердечно-сосудистых осложнений, но сопряжен с повышением вероятности нежелательных явлений со стороны органов пищеварения. В статье представлены современные данные по эпидемиологии, механизмам развития и факторам риска эзофагогастродуодено-и энтеропатий на фоне длительной терапии низкими дозами АСК. Изложены ключевые принципы их профилактики. Ключевые слов: ацетилсалициловая кислота, ингибиторы протонной помпы, эрадикационная терапия.Acetylsalicylic acid (ASA) is highly effective in preventing cardiovascular events, but associated with increased risk for digestive adverse reactions. The paper provides an update on the epidemiology, mechanisms, and risk factors of esophagogastroduodenoand enteropathies during long-term low-dose ACA therapy. It outlines the key principles of their prevention. Key words: acetylsalicylic acid, proton pump inhibitors, eradication therapy.ИМ -инфаркт миокарда НПВП -нестероидные противовоспалительные препараты ОР -относительный риск ОШ -отношение шансов ПО -проксимальные отделы РКИ -рандомизированное клиническое исследование СО -слизистая оболочка ССО -сердечно-сосудистые осложнения ЦОГ-1 -циклооксигеназа-1 ЯБ -язвенная болезнь кишки, визуализированному с помощью капсульной эндоско-пии, в 50% случаев. По сравнению с исходным уровень фекаль-ного кальпротектина (показателя, коррелирующего с гистологи-ческой и эндоскопической активностью воспаления стенки киш-ки) повысился в 4 раза, а коэффициента лактулоза/маннитол (теста на проницаемость кишечной стенки, отражающего ба-рьерную функцию кишечной стенки) -в 1,7 раза [10]. Применяя капсульную эндоскопию для уточнения происхождения ЖКК и/ или болевого абдоминального синдрома у лиц, получавших низ-кие дозы АСК более 3 мес, H. Endo и соавт.[11] в 63,6% случаев выя...

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“…[3][4][5] In hospital-based studies, use of NSAIDs was associated with an increased risk of small-bowel mucosal injury, including ulceration, compared with non-use. 6 However, most previous studies evaluated small-bowel mucosal injuries, 4,[7][8][9][10] and no prospective studies directly evaluated whether these drugs were associated with smallbowel overt bleeding. Thus, it is unclear whether smallbowel mucosal injuries contribute to overt bleeding, which is an important clinical issue.…”

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confidence: 99%

“…3,4,[6][7][8][9][10][11]15,[18][19][20][21][22][23][24][25][26] However, in most studies, the primary endpoint was smallbowel mucosal injury, and the outcomes did not include smallbowel overt bleeding. In addition, these studies had small sample sizes, and half of them included healthy subjects and nonhospital-based patients.…”

mentioning

confidence: 99%

“…In addition, these studies had small sample sizes, and half of them included healthy subjects and nonhospital-based patients. 6,8,9,11,15,18,19,22,23,25,26 Although two of these studies investigated patients with small-bowel overt bleeding, these were retrospectively collected data. 6,11 This is the first multicenter study to use prospectively collected data using capsule endoscopy, enabling the evaluation of two associations: (i) between drug use and small-bowel mucosal injury; and (ii) between drug use and small-bowel overt bleeding in patients with small-bowel mucosal injury.…”

mentioning

confidence: 99%

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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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Small Bowel Injury by Low-Dose Enteric-Coated Aspirin and Treatment With Misoprostol: A Pilot Study

Cited by 153 publications

References 15 publications

Present status and strategy of NSAIDs-induced small bowel injury

Present status and strategy of NSAIDs-induced small bowel injury

Antiplatelet therapy with acetylsalicylic acid: Approaches to reducing the frequency of gastrointenstinal adverse reactions

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

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