Irsogladine improves small-intestinal injuries in regular users of nonsteroidal anti-inflammatory drugs

Isomura, Yoshihiro; Yamaji, Yutaka; Yamada, Atsuo; Watanabe, Yoshitaka; Suzuki, Hirobumi; Kobayashi, Yuka; Yoshida, Shuntaro; Watabe, Hirotsugu; Hirata, Yoshihiro; Yoshida, Haruhiko; Koike, Kazuhiko

doi:10.1016/j.gie.2013.12.030

Cited by 21 publications

(20 citation statements)

References 27 publications

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“…Irsogladine maleate, another mucoprotective drug, improves small intestinal injuries in regular users (>4 weeks) of NSAIDs in a prospective, randomized controlled trial [44]. We also confirmed both prevention and healing effects of irsogladine maleate [45].…”

Section: Current Strategy For Nsaid-induced Small Intestinal Injuriessupporting

confidence: 69%

Current Topics of Strategy of NSAID-Induced Small Intestinal Lesions

et al. 2015

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Small intestinal mucosal injuries have been recently recognized as common complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) because video capsule endoscopy and balloon enteroscopy are now available for the detection of small intestinal lesions. Small intestinal injury occurs not in an acid-dependent mechanism but by various factors such as enteric bacteria, bile acids, prostaglandin (PG) deficiency and topical factors (abnormal intestinal mucosal permeability, mitochondrial dysfunction, reactive oxygen species, endoplasmic reticulum stress and so on), and there is no well-established prophylactic approach. Several experimental and clinical studies found the effectiveness of some of the mucoprotective drugs, PG analogs, but not that of acid suppressants. Considering the effect of proton pump inhibitors (PPIs) for upper gastrointestinal (GI) disease and in the small intestine, the following 2 kinds of strategies against NSAID-induced GI injuries may be recommended. In patients with a high risk of upper GI disease (peptic ulcer etc.), simultaneous administration of a PPI (for upper GI disease) and a mucoprotective drug (for small intestine) is needed to prevent NSAID-induced GI injury. In other cases, an effective mucoprotective drug is enough for the protection of the entire digestive tract, that is, starting from the esophagus to the small intestine. These strategies may fulfill both economical and curative effects.

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Section: Current Strategy For Nsaid-induced Small Intestinal Injuriessupporting

confidence: 69%

Current Topics of Strategy of NSAID-Induced Small Intestinal Lesions

et al. 2015

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“…Moreover, all subjects recruited in the present study did not take any NSAIDs before the study and started diclofenac sodium after the CE screening. Some studies that evaluated the effect of PPIs [7] and other mucosal protective agents such as irsogladine [6] on NSAID-induced smallintestinal mucosal injuries recruited patients who were already being administered regular NSAIDs. Thus, we demonstrated for the first time that the small-intestinal mucosal injuries induced by diclofenac sodium were significantly improved by GGA in patients with rheumatic diseases who did not take NSAIDs in the preceding 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…The slightly modified damage scale in the small intestine was classified as follows [6,13]: category 1, petechiae/red spots (demarcated, usually circular, area of red mucosa with preservation of villi); category 2, reddened folds (≥1 valvulae conniventes showing discrete patchy or continuous erythema); category 3, denuded areas (loss of villous architecture without a clear breach of the epithelium that may or may not be associated with surrounding erythema); category 4, mucosal breaks (mucosal erosions and/or ulcers, both represent discrete lesions with central pallor and surrounding hyperemia and loss of villi; these are included together because by definition, an ulcer requires a degree of penetration (through the muscularis mucosa) and the angle of the image taken by the capsule is often such that it is impossible to evaluate the depth of the lesions); category 5, strictures; and category 6, presence of blood without a visualized lesion.…”

Section: Ce Procedures and Evaluationmentioning

confidence: 99%

“…However, there are still no new promising drugs or breakthrough interventions for NSAID-induced small-intestinal mucosal injuries [5,6]. Proton pump inhibitors (PPIs) effectively prevent NSAIDs-induced gastroduodenal mucosal injuries but are not effective at preventing NSAID-induced small-intestinal mucosal injuries [7].…”

Section: Introductionmentioning

confidence: 99%

“…The pathogenesis of NSAID-induced small-intestinal mucosal injuries includes intestinal hypermotility, microcirculation disorders, decreased mucus secretion, increased mucosal permeability, mucosal invasion of enterobacteria or bile acid and mitochondrial damage-induced disruption of intercellular junctions [6]. intestinal permeability permits mucosal exposure to luminal bacteria with a predictable inflammatory reaction.…”

Section: Introductionmentioning

confidence: 99%

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