Gastroduodenal Mucosal Injury in Patients Taking Low-Dose Aspirin and the Role of Gastric Mucoprotective Drugs: Possible Effect of Rebamipide

Abstract

The present study was conducted to investigate the prevalence of mucosal injury in patients taking low-dose aspirin in Japan and examine the effect of gastric mucoprotective drugs on aspirin-related gastroduodenal toxicity. We selected 530 patients who had taken low-dose aspirin for 1 month or more after undergoing esophagogastroduodenoscopy from 2005 through 2006 at Teikyo University Hospital, Tokyo, Japan. Endoscopic records were retrospectively reviewed to determine the presence of massive bleeding and mucosal injury (ulcer or erosion). The influence of clinical factors, including co-administration of gastroprotective drugs, was also examined. Hemorrhage was observed in 25 patients (3.7%) and mucosal injury (36.2%) in 192 patients. The presence of Helicobacter pylori antibody was a significant risk factor associated with mucosal injury. Patients taking any gastroprotective drug showed a significantly lower rate of mucosal injury than those not taking these drugs. Patients taking rebamipide concomitantly with proton pump inhibitors or histamine 2 receptor antagonists had mucosal injury less frequently than those taking acid suppressants plus other mucoprotective drugs. In conclusion, these results show the possible gastroprotective effects of rebamipide, suggesting that it may be a good choice in aspirin users with gastroduodenal toxicity that is not suppressed by acid suppressants alone.

Should patients prescribed long-term low-dose aspirin receive proton pump inhibitors? A systematic review and meta-analysis

“…This indicates that the study by Yamamoto et al. was the single cause of statistical heterogeneity among the studies reporting on peptic ulcer.…”

“…Exclusion of any single study, except for the study by Yamamoto et al. , did not change the significance of the heterogeneity across the studies. When the study by Yamamoto et al.…”

“…After screening the titles, abstracts and full text, 13 studies were considered eligible for complete data extraction. Of these, four cohort studies reported on the effect on peptic ulcer, five studies [two cohort and three case–control studies ] on GI bleeding, three studies [two RCTs and one cohort study ] on both GI bleeding and peptic ulcer, and one cohort study on both GI bleeding and CV events. Among nine studies that reported on GI bleeding, six studies indicated the outcomes as upper GI bleeding (UGIB) while the others did not specify the location of the bleeding.…”

“…When the study by Yamamoto et al. was excluded, the estimated total inconsistency ( I 2 ) and the between‐study variance (τ 2 ) of the remaining studies were zero (the p‐value of the Q ‐statistic was 0.55). This indicates that the study by Yamamoto et al.…”

Determination of the adequate dosage of rebamipide, a gastric mucoprotective drug, to prevent low-dose aspirin-induced gastrointestinal mucosal injury

“…Several gastric mucoprotective drugs other than PPIs have been found to prevent LDA-induced small intestinal mucosal injury to some degree; (13–18) however, one study found no preventive effect of such drugs on LDA-induced small intestinal mucosal injury. (19) Of note, in the aforementioned reports, the dosages of gastric mucoprotective drugs were those recommended for the treatment of gastric/duodenal ulcers, the so-called “standard dosage”.…”