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Low-dose aspirin (75–325 mg per day) is associated with small-intestine damage. To assess the magnitude of this effect and associated risk factors, investigators in Japan prospectively collected data from 205 patients taking low-dose aspirin who were referred to one of five hospitals for video capsule endoscopy (VCE). All patients had previous negative upper gastrointestinal endoscopy and colonoscopy prior to entry into the study.
Of 198 patients included in the final analysis, 114 (57.6%) had at least one mucosal lesion detected by VCE. In multivariate analysis, only the use of proton-pump inhibitors (PPIs) and use of enteric-coated aspirin were associated with increased risk for mucosal lesions (odds ratios, 2.04 and 4.05, respectively).The authors conclude that PPI use increases the risk for mucosal breaks in the setting of low-dose aspirin therapy.
Endo H et al. Risk factors for small-bowel mucosal breaks in chronic low-dose aspirin users: Data from a prospective multicenter capsule endoscopy registry. Gastrointest Endosc 2014 May 13; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.gie.2014.03.024)
Comment
Other studies have demonstrated that PPI use increases the severity of small-bowel enteropathy, possibly because of increased bacterial colonization. The use of VCE to quantitate small-bowel enteropathy induced by aspirin or nonsteroidal anti-inflammatory drugs likely underestimates the scope of the problem. Increased mucosal permeability is a common effect of these drugs and may occur in the absence of visible mucosal lesions.