Prospective Study
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World J Gastrointest Endosc. Dec 16, 2014; 6(12): 612-619
Published online Dec 16, 2014. doi: 10.4253/wjge.v6.i12.612
Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding
Panagiotis Tsibouris, Chissostomos Kalantzis, Periklis Apostolopoulos, Antonios Zalonis, Peter Edward Thomas Isaacs, Mark Hendrickse, Georgios Alexandrakis
Panagiotis Tsibouris, Chissostomos Kalantzis, Periklis Apostolopoulos, Antonios Zalonis, Georgios Alexandrakis, Department of Gastroenterology, NIMTS General Hospital, 11521 Athens, Greece
Peter Edward Thomas Isaacs, Mark Hendrickse, Gastroenterologist Blackpool Victoria Hospital, Blackpool, FY3 8NR Lancashire, United Kingdom
Author contributions: Tsibouris P designed and analyzed the research; Tsibouris P, Kalantzis C, Apostolopoulos P, Zalonis A and Alexandrakis G performed the research; Tsibouris P, Isaacs PET and Hendrickse M wrote the paper.
Supported by Patients or their insurance for capsule endoscopy; by NIMTS General Hospital
Correspondence to: Panagiotis Tsibouris, PhD, Consultant Gastroenterologist, Department of Gastroenterology, NIMTS General Hospital, 10-12 Monis Petraki Str, 11521 Athens, Greece. tsibofam@yahoo.com
Telephone: +30-21-07288107 Fax: +30-21-07257823
Received: August 3, 2014
Revised: November 5, 2014
Accepted: November 17, 2014
Published online: December 16, 2014
Core Tip

Core tip: Non-steroidal anti-inflammatory drugs (NSAIDs) can frequently cause small bowel ulcerative lesions. In our prospective case control study we found that 95% of elderly patients with peptic ulcer bleeding consuming NSAIDs also presented small bowel erosions and 55% small bowel ulcers. Small bowel ulcerative lesions were 3 times less frequent in patients with a non-bleeding peptic ulcer consuming NSAIDs, and infrequent among patients with a peptic ulcer not receiving NSAIDs. Small bowel ulcers in peptic ulcer bleeders were related with lower entry hemoglobin and increased need for blood transfusion. Moreover, they could be incriminated for unexplained bleeding recurrence despite successful peptic ulcer hemostasis.