The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy

Negovan, Anca; Iancu, Mihaela; Moldovan, Valeriu; Sarkany, Kinga; Bățagă, Simona; Mocan, Simona; Ţilea, Ioan; Bănescu, Claudia

doi:10.1016/j.ejim.2017.05.017

Cited by 16 publications

(16 citation statements)

References 36 publications

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“…Our findings suggest that male gender was more frequently associated with CHF and severe lesions on endoscopy. In our previous research we obtained similar results regarding the severity of endoscopic lesions in patients consuming LDA [17]. Male gender presents cardiovascular diseases more commonly than females, due to hormonal differences [25].…”

Section: Discussionsupporting

confidence: 60%

“…Many patients with CHF use antithrombotic treatments, antiplatelet and/or anticoagulants. These drugs promote the blood loss by the entire GIT from various mucosal lesions [17,18,19,20]. Furthermore, gastrointestinal conditions that do not usually induce bleeding, frequently associate iron deficiency anemia due to impairment of iron metabolism [21].…”

Section: Discussionmentioning

confidence: 99%

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Congestive Heart Failure and Upper Digestive Endoscopic Lesions

Cosma¹,

Bănescu

Mocan³

et al. 2019

Acta Medica Marisiensis

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Objective: To evaluate the impact of congestive heart failure and the most important clinical and pathological factors on severe upper digestive mucosal lesions.Methods: The study included 749 patients referred for upper digestive endoscopy, divided into two groups: 140 subjects with congestive heart failure (study group) and 609 subjects without heart failure (control group).Results: Severe endoscopic lesions quantified according to Lanza score (OR = 3.84, 95% IC: 2.62-5.62), active/inactive gastritis (OR = 2.07, 95% CI: 1.36-3.14), intestinal metaplasia and/or gastric atrophy (OR = 2.42, 95% CI: 1.67-3.52) were significant more frequent among patients with heart failure. Anemia (OR = 3.65, 95% IC: 2.48-5.37) and all investigated comorbidities, as well as alcohol consumption (OR = 1.60, 95% IC: 1.10-2.34) and smoking (OR = 1.76, 95% IC: 1.17-2.64) were more frequent in the study-group. Dividing the patients with cardiac insufficiency according to the severity of their endoscopic lesions, the male gender (OR = 2.76, 95% IC: 1.35–5.61) and daily low-dose aspirin consumption were found to be more frequent among patients with severe endoscopic lesions (OR = 7.71, 95% IC: 3.62–16.40), while anticoagulant therapy and alcohol consumption were borderline associated with mucosal lesions (p=0.08).Conclusions: Male patients and aspirin consumers with heart failure, but not those with H. pylori infection seem to be more prone to develop upper digestive endoscopic lesions, while alcohol consumption or anticoagulant therapy could be other modifiable factors associated with severe endoscopic lesions in a congestive gastro-duodenal mucosa.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Congestive Heart Failure and Upper Digestive Endoscopic Lesions

Cosma¹,

Bănescu

Mocan³

et al. 2019

Acta Medica Marisiensis

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“…6 Premalignant gastric lesions were observed in 39.5% of patients in the present study, GA representing 26.4%, IM 18.7%, and dysplasia 0.7%, higher than in other European populations, but comparable with Asian studies and similar with our previous reports. 7 Patients on statin therapy had a lower frequency of premalignant lesions than those in the no-statin group (35.4% vs. 42.1%, p = 0.33), but the difference was not significant.…”

Section: Discussionmentioning

confidence: 80%

Chronic Statin Therapy and Histologic Gastric Changes

Negovan

Ţilea

Voidăzan

et al. 2018

Journal of Interdisciplinary Medicine

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Background: The additional benefits of certain frequently used chronic drugs such as statins or aspirin are investigated for their possible effect of influencing various types of cancer, including gastric cancer. The possible role of statins in the occurrence of pre-neoplastic gastric lesions has not been investigated. Aim: The study aims to determine the influence of chronic statin therapy on premalignant gastric lesions (glandular atrophy, intestinal metaplasia and dysplasia), adjusted with the most important aggressive environmental factors of the gastric mucosa (Helicobacter pylori [H. pylori] infection, low-dose aspirin [acetylsalicylic acid, ASA], biliary reflux, smoking, alcohol consumption). Method: The study included 566 patients with cardiovascular diseases who underwent an upper endoscopy: 222 patients with chronic statin therapy (atorvastatin 20–80 mg/day or rosuvastatin 5–20 mg/day for at least 6 months) and 344 patients without statin intake. A complete set of biopsies from the gastric antrum and corpus were routinely processed and examined, and demographical, clinical, and pathological variables were recorded. Results: Active H. pylori infection in gastric biopsies (p = 0.45), biliary reflux (p = 0.74), alcohol consumption (p = 0.43), or prior ulcer disease (p = 0.07; OR: 0.59; 95% CI: 0.33–1.04) were not associated with an increased risk for premalignant lesions, neither in the statin, nor the no-statin group. Smoking was associated with premalignant lesions in both groups (p = 0.01; OR: 2.24; 95% CI: 1.12–4.47; and p = 0.04; OR: 1.72; 95% CI: 1.01–2.94, respectively), while chronic use of ASA had no influence (p = 0.24, respective p = 0.35). In multivariate regression models, chronic treatment with statins had a protective effect (p = 0.006; OR: 0.59; 95% CI: 0.4–0.8), while smoking (p = 0.01; OR: 1.99; 95% CI: 1.17–3.39) and age >50 years (p <0.01, OR: 3.09; 95% CI: 1.84–5.21) were predictors for pre-neoplastic lesions. H. pylori infection, gender, alcohol consumption, biliary reflux, or prior ulcer disease were not associated with premalignant lesions (p >0.05). Conclusions: In the studied population, chronic statin treatment seems to be associated with a decreased risk for premalignant gastric lesions, while age over 50 years and smoking, regardless of gender or ASA consumption, remain the most important risk factors for premalignant gastric lesions.

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“…In our study, we noticed that the presence of AC/CC genotypes of AGT c.-58 A>C was associated with the progression of gastric inflammatory lesions in patients without cardiovascular disease. Contrariwise, recent research in this respect, demonstrates that congestive heart failure has a tendency towards statistical significance in influencing the progression of critical gastro-duodenal lesions (23). In literature, the findings of large-scale follow-up studies are principally all in agreement that inflammatory and premalignant lesions increase with age (24).…”

Section: Discussionmentioning

confidence: 91%

The angiotensinogen gene polymorphism, lifestyle factors, associated diseases and gastric areas of inflammatory and preneoplastic lesions in a Romanian sample of patients

Anciuc¹,

Tripon

Crauciuc

et al. 2019

Revista Romana De Medicina De Laborator

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The aim of our study was to evaluate the association between variant genotype of angiotensinogen (AGT) c.-58A>C, lifestyle factors and clinical factors and corporeal extension of gastric inflammatory and preneoplastic lesions. Methods: Our study included 209 subjects who underwent a complete set of gastric biopsies, followed by genotyping. They were included to study inflammatory gastric changes and preneoplastic lesions and were grouped according to the localization of changes. Results: No significant statistical associations were noticed between AGT c.-58A>C genotypes and the corporeal extension of the inflammation or preneoplastic injury groups. Extending preneoplastic lesions to the gastric body was associated with smoking habits (p=0.01) and additionally, there was a significant association between nicotine consumption and the body extension of preneoplastic lesions (p=0.01). The use of acenocoumarol was frequently associated with the progression of histological lesions to preneoplastic lesions (p=0.01). Compared with the wild-type AA genotype, the combined genotypes AA+CC of AGT c.-58A>C were significantly associated with the progression of inflammatory gastric lesions’ according to the regular ingested doses of nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusion: The AGT c.-58A>C polymorphism is not associated with extension of the gastric lesions. In accordance with nicotine and alcohol consumption, the acenocoumarol co-treatment and multiple cardiac pathologies are associated with the corporeal progression of these injuries. The age below 70 years and NSAIDs treatment for the patients with heterozygous AC genotype and variant homozygous CC genotype for the mentioned SNP have been associated with the corporeal extension of gastric inflammation.

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The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy

Cited by 16 publications

References 36 publications

Congestive Heart Failure and Upper Digestive Endoscopic Lesions

Congestive Heart Failure and Upper Digestive Endoscopic Lesions

Chronic Statin Therapy and Histologic Gastric Changes

The angiotensinogen gene polymorphism, lifestyle factors, associated diseases and gastric areas of inflammatory and preneoplastic lesions in a Romanian sample of patients

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