Risk factors for small bowel bleeding in chronic nonsteroidal anti‐inflammatory drug users

Cho, Kyuman; Park, Seon-Young; Chung, Jin Ook; Jun, Chung‐Hwan; Kim, Tae‐Jong; Son, Dong-Jun; Kim, Ban-Suk; Park, Chang-Hwan; Kim, Hyunsoo; Choi, Sung‐Kyu; Rew, Jong Sun

doi:10.1111/1751-2980.12269

Cited by 9 publications

(3 citation statements)

References 24 publications

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“…NSAIDs-induced intestinal damage includes the development of increased mucosal permeability, inflammation, erosion, ulcer, malabsorption, stricture, perforation, and intestinal bleeding [ 15 – 17 ]. Obscure gastrointestinal (GI) bleeding was the most frequent clinical manifestation (75.11%), followed by nonspecific symptoms (21.72%) and obstruction (3.17%) in the NSAIDs group in the present study [ 18 , 19 ]. The diagnostic accuracy rates for NSAIDs injuries was 49.77%, which agrees with results of other studies [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 67%

Characteristics of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)-Induced Small Bowel Injury Identified by Single-Balloon Endoscopy or Capsule Endoscopy

Cao

et al. 2017

Med Sci Monit

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BackgroundThe special features of nonsteroidal anti-inflammatory drugs (NSAIDs) enteropathy were partially clarified by single-balloon endoscopy(SBE).We aimed to investigate the characteristics of NSAIDs injuries that were differ from other ulcer diseases and efficacy of SBE compared with capsule endoscopy(CE).Material/Methods1,644 symptomatic patients (221 patients taking NSAIDs) hospitalized between January 2006 and March 2016 were recruited and underwent SBE and/or CE.ResultsNSAIDs damages were identified in 110 patients (49.77%). The special features of NSAIDs lesions included: variform, superficial, multiple and irregular arrangement; <1 cm in diameter (67.27%); the location in jejunum and ileum was similar; ileocecal valve was rarely influenced (20.91%). The specificity and positive predictive value of SBE for diagnosing NSAIDs breaks were higher than CE (95.74% vs. 80.00%; 95.45% vs. 81.63%, p<0.05). There were no differences in the detection rate and the diagnostic accuracy rate of small bowel diseases between SBE and CE in the NSAIDs group (69.4% vs. 66.3% and 83.58% vs. 80.65%, p>0.05 respectively). The consistency in diagnosing NSAIDs breaks for the 2 methods was 82.61%. More tiny lesions at the distal ileum were detected by SBE. Four patients misdiagnosed by CE got accurate diagnose through biopsy by SBE. Three patients with active bleeding caused by NSAIDs-induced ulcers underwent hemostasis successfully by SBE.ConclusionsNSAIDs injuries might be distinguished from other diseases by endoscopic features and biopsy through SBE, which appeared to be an effective method for diagnosis and treatment.

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Section: Discussionmentioning

confidence: 67%

Characteristics of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)-Induced Small Bowel Injury Identified by Single-Balloon Endoscopy or Capsule Endoscopy

Cao

et al. 2017

Med Sci Monit

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“…However, in population-based studies, no consistent conclusions have been reached about the association between PPI and NSAID-related small bowel damage, which has been explored from the development of small bowel injury to clinically significant small bowel bleeding. ( 6 , 7 ). Owing to the combination of PPIs and NSAIDs leading to excessive costs for both patients and governments, this potential risk for iatrogenic harm has an essential impact on clinical practice ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors Increase the Risk of Nonsteroidal Anti-inflammatory Drug-Related Small-Bowel Injury: A Systematic Review With Meta-analysis

Zhang

Xiao

Chen

et al. 2023

Clin Transl Gastroenterol

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INTRODUCTION: Conflicting results exist on the association between proton-pump inhibitor (PPI) and nonsteroidal anti-inflammatory drug (NSAID)-related small-bowel damage. The aim of this study was to determine whether PPIs increased the risk of NSAID-related small-bowel damage by meta-analysis. METHODS: A systematic electronic search in PubMed, Embase, and Web of Science was conducted from the time the database was created until March 31, 2022, for studies reporting associations between PPI use and outcomes, including the endoscopy-verified prevalence of small-bowel injury, mean number of small-bowel injuries per patient, change in hemoglobin level, and risk of small-bowel bleeding in subjects taking NSAIDs. Meta-analytical calculations for odds ratio (OR) and mean difference (MD) were performed with the random-effects model and interpreted with 95% confidence intervals (CIs). RESULTS: Fourteen studies comprising 1996 subjects were included. Pooled analysis demonstrated that concomitant use of PPIs significantly increased the prevalence and number of endoscopy-verified small-bowel injuries (prevalence: OR = 3.00; 95% CI: 1.74–5.16; number: MD = 2.30; 95% CI: 0.61–3.99) and decreased hemoglobin levels (MD = −0.50 g/dL; 95% CI: 0.88 to −0.12) in NSAID users but did not change the risk of small-bowel bleeding (OR = 1.24; 95% CI: 0.80–1.92). Subgroup analysis demonstrated that PPIs significantly increased the prevalence of small-bowel injury in subjects taking nonselective NSAIDs (OR = 7.05; 95% CI: 4.70–10.59, 4 studies, I2 = 0) and COX-2 inhibitors (OR = 4.00; 95% CI: 1.18–13.60, 1 study, no calculated I2) when compared with COX-2 inhibitors alone. DISCUSSION: PPIs increased the risk of NSAID-related small-bowel damage, and the clinical significance of higher prevalence of small-bowel injuries should be studied in the future.

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“…But, being an invasive modality, it can only be used to observe the upper digestive tract (esophagus, stomach, and duodenum). On the other hand, traditional CE can only screen the small intestinal mucosa [7]. Therefore, there is a lack of clinical methods to simultaneously screen for gastric and small intestinal mucosal injury in patients taking enteric-coated aspirin.…”

Section: Introductionmentioning

confidence: 99%

Screening for Gastric and Small Intestinal Mucosal Injury with Magnetically Controlled Capsule Endoscopy in Asymptomatic Patients Taking Enteric-Coated Aspirin

Xue

Gao

Zhang

2018

Gastroenterology Research and Practice

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Objective To investigate gastric and small intestinal mucosal injury in asymptomatic patients taking enteric-coated aspirin using magnetically controlled capsule endoscopy. Methods Patients taking enteric-coated aspirin (aspirin group) and healthy controls (control group) were recruited from Beijing Anzhen Hospital, Capital Medical University, between September 2017 and May 2018, and undertook magnetically controlled capsule endoscopy. Results Twenty-six subjects were recruited to the aspirin group and twenty-six to the control group; the median Gastrointestinal Symptom Rating Scale scores were 3.50 and 3.00 (P = 0.200), the median gastric Lanza scores were 2.50 and 1.00 (P < 0.001), the small intestinal Lanza scores were 1.00 and 0.00 (P < 0.001), the gastric controlled examination times were 50.0 and 51.0 min (P = 0.171), the small intestinal transit times were 240.0 and 238.0 min (P = 0.654), and the capsule excretion times were 24.0 and 24.0 hours (P = 0.956), respectively. Conclusions Rates of gastric and small intestinal mucosal injuries were significantly higher in patients without obvious gastrointestinal symptoms taking enteric-coated aspirin compared to healthy controls. Magnetically controlled capsule endoscopy constitutes a safe, real-time screening modality for gastric and small intestinal mucosal injury in patients taking enteric-coated aspirin.

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Risk factors for small bowel bleeding in chronic nonsteroidal anti‐inflammatory drug users

Abstract: Coronary artery disease and co-use of thienopyridine were associated with SBB in NSAIDs users. The patients with coronary artery disease co-using thienopyridine need to be monitored for the occurrence of SBB when they were prescribed with NSAIDs.

Cited by 9 publications

References 24 publications

Characteristics of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)-Induced Small Bowel Injury Identified by Single-Balloon Endoscopy or Capsule Endoscopy

Characteristics of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)-Induced Small Bowel Injury Identified by Single-Balloon Endoscopy or Capsule Endoscopy

Proton Pump Inhibitors Increase the Risk of Nonsteroidal Anti-inflammatory Drug-Related Small-Bowel Injury: A Systematic Review With Meta-analysis

Screening for Gastric and Small Intestinal Mucosal Injury with Magnetically Controlled Capsule Endoscopy in Asymptomatic Patients Taking Enteric-Coated Aspirin

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