Hiroki Endo, MD, PhD from the Division of Gastroenterology, Yokohama City University School of Medicine in Yokohama, Japan discusses his Original Article “Risk factors for small-bowel mucosal breaks in chronic low-dose aspirin users: data from a prospective multicenter capsule endoscopy registry.”
The aim of this capsule endoscopy study was to evaluate the risk factors for the development of small bowel mucosal breaks in chronic low-dose aspirin users.
For the prevention of small bowel mucosal injury in patients receiving low-dose aspirin, it is important to identify the risk factors for the development of such injury in these patients. Some key strategies have been proposed to minimize the upper-gastrointestinal adverse effects of low-dose aspirin, such as reducing the influence of modifiable risk factors, reducing the aspirin dose, and concomitant use of a gastroprotective agent, preferably a proton pump inhibitor. However, there are as yet no data on the risk factors for the development of small bowel injury among patients receiving low-dose aspirin.
We demonstrated that the use of PPI and enteric-coated aspirin were associated with an increase in the risk of small bowel mucosal breaks in low-dose aspirin users, with ORs of 2.04 and 4.05, respectively. Although PPIs have been demonstrated to reduce the incidence of gastroduodenal injuries related to NSAIDs or aspirin, their protective effect against small bowel injuries remains controversial. Data from this study demonstrate that PPI use can exacerbate the risk of small bowel injury in chronic low-dose aspirin users. This interesting finding is in conflict with the known decrease in the risk of aspirin-induced gastric ulcers. It is necessary for clinicians to recognize this dilemma of PPI therapy, and novel means of the treatment of aspirin-induced gastroenteropathy are urgently needed.
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