Characteristics of small bowel injury in symptomatic chronic low-dose aspirin users: the experience of two medical centers in capsule endoscopy

Endo, Hideki; Hosono, Kunihiro; Inamori, Masahiko; Nozaki, Yuichi; Yoneda, Kyoko; Fujita, Koji; Takahashi, Hirokazu; Yoneda, Masato; Abe, Yasunobu; Kohno, Hiroyuki; Kobayashi, Noritoshi; Kubota, Kensuke; Saito, Satoru; Ohya, Tomohiko R.; Hisatomi, Kantaro; Teratani, Takuma; Matsuhashi, Nobuyuki; Nakajima, Atsushi

doi:10.1007/s00535-009-0040-z

Cited by 72 publications

(68 citation statements)

References 25 publications

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“…The reported incidence of LDA-induced small-bowel mucosal injury is 20-61.5% among healthy volunteers using short-term LDA, [24,28,29,30] and the reported prevalence of LDA-induced small-bowel mucosal injury is 42.1-100%, specifically among patients with OGIB using long-term LDA [14,24,31,32]. It is difficult to perform CE in all patients who receive NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

“…If the endoscopists' findings differed, consensus was reached through discussion. NSAID-induced small-bowel mucosal injuries are characterized by multiple petechiae/red spots, denuded area, scars, mucosal erosions, and ulcers with a round, irregular, or punched-out appearance or circumferential ulcers with stricture [14,17]. In this study, small-bowel mucosal injuries were classified in the following manner [20,21]: erosion, a white spot surrounded by a red halo; ulcer, depression with a white coating; reddened lesion, reddish mucosal changes, including reddened folds, denuded areas, and/or petechiae (fig.…”

Section: Methodsmentioning

confidence: 99%

“…The characteristics of LDA-induced small-bowel mucosal injuries and NSAID-induced small-bowel mucosal injuries have been reported previously [14,15,16,17,18]. Most of the relevant studies have been performed on healthy volunteers with short-term NSAID use.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Small-Bowel Mucosal Injury between Low-Dose Aspirin and Non-Aspirin Non-Steroidal Anti-Inflammatory Drugs: A Capsule Endoscopy Study

et al. 2014

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Background/Aims: The differences in the severity of small-bowel toxicity induced by aspirin and non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) remain unclear. This study aimed at clarifying these differences in small-bowel mucosal injury by using capsule endoscopy (CE). Methods: We retrospectively compared the records of 78 and 40 obscure gastrointestinal bleeding patients receiving low-dose aspirin (LDA) and non-aspirin NSAIDs, respectively. All patients were found to have small-bowel mucosal injuries on CE. The two groups were compared for the number of small-bowel mucosal injuries and CE scores on the basis of the findings of CE. Results: The mean numbers of reddened lesions in the LDA group and non-aspirin NSAID group were 2.49 ± 3.15 and 1.65 ± 3.04; the mean numbers of erosions/ulcers 1.56 ± 3.75 and 6.08 ± 10.4, and the mean CE scores 154 ± 294 and 520 ± 758, respectively. The mean number of reddened lesions was significantly higher and the mean number of erosions/ulcers and CE scores significantly lower in the LDA group than in the other non-aspirin NSAID group. Conclusion: Small-bowel mucosal injuries were significantly milder in the LDA group than in the non-aspirin NSAID group, though reddened lesions were more frequent in the LDA group.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Comparison of Small-Bowel Mucosal Injury between Low-Dose Aspirin and Non-Aspirin Non-Steroidal Anti-Inflammatory Drugs: A Capsule Endoscopy Study

et al. 2014

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“…In cases of incomplete CE, significant lesions outside the observation range may be missed. For example, small bowel ulcers in chronic low-dose aspirin users tend to exist in the distal part of the small bowel [18]. Incomplete CE would be associated with a lower likelihood of visualization of these lesions, making the procedure wasteful.…”

Section: Discussionmentioning

confidence: 99%

Optimal Approach for Small Bowel Capsule Endoscopy Using Polyethylene Glycol and Metoclopramide with the Assistance of a Real-Time Viewer

Hosono

Endo²,

Shimizu³

et al. 2011

Digestion

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Aim: Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer. Methods: A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the ‘conventional group’ (without any preparation) and the ‘real-time group’ (in which a real-time viewer was attached). At 60 min after swallowing the capsule, if the capsule hadreached the small bowel, 500 ml of polyethylene glycol was administered; if the capsule was still located in the stomach, 10 mg of metoclopramide was given intramuscularly, followed by 500 ml of polyethylene glycol solution. Results: The completion rate was significantly higher in the real-time group as compared with that in the conventional group (72.5 vs. 90.0%). Our protocol yielded a significantly improved image quality of the distal small bowel [image quality score = 1.6 vs. 3.0 (max 4.0)]. The detection rate of lesions in the distal small bowel was higher in the real-time group than in the conventional group. Conclusions: The present study clearly showed that our protocol yielded an improved completion rate and also improved image quality.

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“…Switching from one NSAID to another does not offer any benefit, because enteropathy has been reported with most conventional NSAIDs, including acetylsalicylic acid. 2,7 Despite an initial report that COX-2 inhibitors produced no change in intestinal permeability in healthy volunteers, 8 a recent study noted smallbowel injury in up to 50% of patients taking COX-2-selective agents for three months or longer. 9 No statistically significant difference in the prevalence of small-bowel injury was noted between patients taking COX-2-selective agents and those taking conventional NSAIDs.…”

Section: Treatmentmentioning

confidence: 99%

Meloxicam-induced enteropathy of the small bowel

Are

Turagam²,

Aucar³

et al. 2010

Canadian Medical Association Journal

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Characteristics of small bowel injury in symptomatic chronic low-dose aspirin users: the experience of two medical centers in capsule endoscopy

Abstract: This is the first CE report that has studied the characteristics of small bowel injury in chronic LDA users. CE is useful to diagnose small bowel enteropathy associated with LDA.

Cited by 72 publications

References 25 publications

Comparison of Small-Bowel Mucosal Injury between Low-Dose Aspirin and Non-Aspirin Non-Steroidal Anti-Inflammatory Drugs: A Capsule Endoscopy Study

Comparison of Small-Bowel Mucosal Injury between Low-Dose Aspirin and Non-Aspirin Non-Steroidal Anti-Inflammatory Drugs: A Capsule Endoscopy Study

Optimal Approach for Small Bowel Capsule Endoscopy Using Polyethylene Glycol and Metoclopramide with the Assistance of a Real-Time Viewer

Meloxicam-induced enteropathy of the small bowel

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