Case Control Study
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World J Gastroenterol. Sep 28, 2014; 20(36): 13133-13138
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13133
Small-bowel mucosal injuries in low-dose aspirin users with obscure gastrointestinal bleeding
Junichi Iwamoto, Yuji Mizokami, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki
Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
Yuji Mizokami, Department of Gastroenterology, University of Tsukuba, Ibaraki 305-8576, Japan
Author contributions: Iwamoto J and Shimokobe K analyzed the clinical data; Mizokami Y, Saito Y, Honda A, Ikegami T and Matsuzaki Y were also involved in editing the manuscript; Iwamoto J designed the study and wrote the manuscript.
Correspondence to: Junichi Iwamoto, MD, PhD, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Ami-machi Chuo, Inashiki-gun, Ibaraki 300-0395, Japan. junnki@dg.mbn.or.jp
Telephone: +81-29-8871161 Fax: +81-29-8883463
Received: December 10, 2013
Revised: January 18, 2014
Accepted: June 20, 2014
Published online: September 28, 2014
Abstract

AIM: To investigate the clinical differences between small intestinal injuries in low-dose aspirin (LDA) users and in non-steroidal anti-inflammatory drug (NSAID) users who were examined by capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB).

METHODS: A total of 181 patients who underwent CE for OGIB were included in this study. Based on clinical records, laboratory data such as hemoglobin levels, major symptoms, underlying diseases, the types and duration of LDA and NSAID use, and endoscopic characteristics of CE were reviewed.

RESULTS: Out of a total of 45 cases of erosive lesions, 27 cases were taking LDA or NSAIDs (7 were on NSAIDs, 9 were on LDA alone, 9 were on LDA and thienopyridine, and 2 were on LDA and warfarin).The prevalence of ulcers or erosion during chronic use of LDA, LDA and the anti-platelet drug thienopyridine (clopidogrel or ticlopidine), and NSAIDs were 64.3%, 80.0%, and 75.0%, respectively. Erosive lesions were observed predominantly in chronic LDA users, while ulcerative lesions were detected mainly in NSAID users. However, concomitant use of thienopyridine such as clopidogrel with LDA increased the proportion of ulcers. The erosive lesions were located in the whole of the small intestine (jejunum and ileum), whereas ulcerative lesions were mainly observed in the ileum (P < 0.05).

CONCLUSION: Our CE findings indicate that chronic LDA users and NSAID users show different types and locations of small-bowel mucosal injuries. The concomitant use of anti-platelet drugs with LDA tends to exacerbate the injuries from LDA-type to NSAID-type injuries.

Keywords: Non-steroidal anti-inflammatory drugs, Low-dose aspirin, Small-bowel mucosal injuries, Obscure gastrointestinal bleeding, Capsule endoscopy

Core tip: The aim of this study is that to clarify the clinical feature of ulcerative or erosive lesion of small intestine in the long-term non-steroidal anti-inflammatory drug (NSAID) users who were examined by capsule endoscopy for obscure gastrointestinal bleeding. The ulcerative lesions were predominantly located in both jejunum and ileum or just in ileum while erosive lesions were predominantly found in both jejunum and ileum or just in jejunum significantly. These findings indicate the possibility that distribution of NSAID-induced small intestinal lesion differ according to the types of mucosal injury.