Incidence of Small Bowel Injury Induced by Low-Dose Aspirin: A Crossover Study Using Capsule Endoscopy in Healthy Volunteers

Endo, Hideki; Hosono, Kunihiro; Inamori, Masahiko; Kato, Shingo; Nozaki, Yuichi; Yoneda, Kyoko; Akiyama, Tomoyuki; Fujita, Koji; Takahashi, Hirokazu; Yoneda, Masato; Abe, Yasunobu; Kohno, Hiroyuki; Kobayashi, Noritoshi; Kubota, Kensuke; Saito, Satoru; Matsuhashi, Nobuyuki; Nakajima, Atsushi

doi:10.1159/000204465

Cited by 76 publications

(44 citation statements)

References 50 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%

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%

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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“…Previous studies have suggested that low-dose aspirin is unlikely to cause significant small bowel injury [7,8]. However, several recent studies indicated that small bowel injury was caused by low-dose aspirin [22][23][24][25]. Smecol et al [24] reported increased fecal calprotectin after administration of 100 mg of aspirin for 2 weeks in 20 healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

Randomized, double-blind, pilot study of geranylgeranylacetone versus placebo in patients taking low-dose enteric-coated aspirin. Low-dose aspirin-induced small bowel damage

Shiotani¹,

Haruma²,

Nishi³

et al. 2009

Scandinavian Journal of Gastroenterology

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Objective. Low-dose enteric-coated aspirin is increasingly being used for prevention of cardiovascular disease. The aim of this study was to evaluate whether geranylgeranylacetone (GGA) could prevent aspirin-induced small bowel injury. Material and methods. This was a prospective, randomized, double-blind, pilot study of GGA versus placebo in subjects taking low-dose enteric-coated aspirin. Young healthy volunteers were enrolled and each received 100 mg of enteric-coated aspirin per day plus either GGA (150 mg/day) or matching placebo for 7 days. Video capsule endoscopy of the small bowel and the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire were performed before and after the administration of aspirin. Results. Twenty volunteers were evaluated. There was no significant difference in the number of lesions in any category between those receiving or not receiving GGA. Large erosions or ulcers were observed in 12 (60%; 95% confidence interval 36%-80%) aspirin users. Mucosal breaks were most frequently found in the latter half of the proximal small bowel. Conclusions. Short-term administration of low-dose enteric-coated aspirin was associated with visible small bowel damage in the majority of users. We could not prove that aspirin-induced small bowel mucosal injury was prevented by GGA.

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“…Maiden et al [25] reported gross damage in 68% of healthy volunteers taking diclofenac plus omeprazole for 2 wk. Even low-dose aspirin was found to cause significant small intestinal damage with short-term administration; thus, Endo et al [26] reported that 80% of patients taking low-dose aspirin for 2 wk had intestinal damage.…”

Section: Detection Of Nsaid-enteropathymentioning

confidence: 99%

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Wallace¹

2013

WJG

151

148

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This article reviews the latest developments in understanding the pathogenesis, detection and treatment of small intestinal damage and bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs). With improvements in the detection of NSAID-induced damage in the small intestine, it is now clear that this injury and the associated bleeding occurs more frequently than that occurring in the stomach and duodenum, and can also be regarded as more dangerous. However, there are no proven-effective therapies for NSAIDenteropathy, and detection remains a challenge, particularly because of the poor correlation between tissue injury and symptoms. Moreover, recent studies suggest that commonly used drugs for protecting the upper gastrointestinal tract (i.e. , proton pump inhibitors) can significantly worsen NSAID-induced damage in the small intestine. The pathogenesis of NSAIDenteropathy is complex, but studies in animal models are shedding light on the key factors that contribute to ulceration and bleeding, and are providing clues to the development of effective therapies and prevention strategies. Novel NSAIDs that do not cause small in- FRONTIER

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Incidence of Small Bowel Injury Induced by Low-Dose Aspirin: A Crossover Study Using Capsule Endoscopy in Healthy Volunteers

Cited by 76 publications

References 50 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

Randomized, double-blind, pilot study of geranylgeranylacetone versus placebo in patients taking low-dose enteric-coated aspirin. Low-dose aspirin-induced small bowel damage

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

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