Small bowel injury in low-dose aspirin users

Abstract

The use of low-dose aspirin (LDA) is well known to be associated with an increased risk of serious upper gastrointestinal complications, such as peptic ulceration and bleeding. Until recently, attention was mainly focused on aspirin-induced damage of the stomach and duodenum. However, recently, there has been growing interest among gastroenterologists on the adverse effects of aspirin on the small bowel, especially as new endoscopic techniques, such as capsule endoscopy (CE) and balloon-assisted endoscopy, have become available for the evaluation of small bowel lesions. Preliminary CE studies conducted in healthy subjects have shown that short-term administration of LDA can induce mild mucosal inflammation of the small bowel. Furthermore, chronic use of LDA results in a variety of lesions in the small bowel, including multiple petechiae, loss of villi, erosions, and round, irregular, or punched-out ulcers. Some patients develop circumferential ulcers with stricture. In addition, to reduce the incidence of gastrointestinal lesions in LDA users, it is important for clinicians to confirm the differences in the gastrointestinal toxicity between different types of aspirin formulations in clinical use. Some studies suggest that enteric-coated aspirin may be more injurious to the small bowel mucosa than buffered aspirin. The ideal treatment for small bowel injury in patients taking LDA would be withdrawal of aspirin, however, LDA is used as an antiplatelet agent in the majority of patients, and its withdrawal could increase the risk of cardiovascular/cerebrovascular morbidity and mortality. Thus, novel means for the treatment of aspirin-induced enteropathy are urgently needed.

Gastrointestinal endoscopy in patients on anticoagulant therapy and antiplatelet agents

“…The role of APAs in causing colonic bleeding, mainly in diverticula, has been pointed out more recently [33]. Similarly, small bowel bleeding caused by APAs, mainly erosive enteropathy, is increasingly recognized [32]. …”

A Small Bowel Ulcer due to Clopidogrel with Cytomegalovirus Enteritis Diagnosed by Capsule and Double-Balloon Endoscopy

“…Various features of gastrointestinal lesions due to LDA have been described such as multiple petechiae, loss of villi, erosions, and round, irregular, and punched-out ulcers [ 10 ]. In fact, it is difficult to diagnose the cause of small bowel injuries.…”

HPLC/PDA/ESI-MS/MS analysis of chamomile decoction and mechanism of its protective effects on aspirin-induced small bowel injuries

“…Indeed, several studies have shown that aspirin is associated with an inammatory state via the expression of proinammatory cytokines. 4,36 Although, inammatory state and oxidative stress are intimately linked, as shown by the constant elevation of oxidative stress markers during inammatory bowel disease. 54 Thus, taking antioxidants is an important therapeutic strategy for ghting inammation.…”