title: Small bowel injury by low-dose enteric-coated aspirin and treatment with misoprostol: a pilot study.
abstract: OBJECTIVE
  With capsule endoscopy, the ulcerogenic effect of low-dose enteric-coated aspirin on the small bowel and the therapeutic effect of misoprostol on intestinal injury were evaluated.
  
  
  METHODS
  Eleven patients who developed gastric ulcers while undergoing low-dose enteric-coated aspirin therapy were enrolled. They continued aspirin therapy while taking proton pump inhibitors (PPIs) for 8 weeks to heal the gastric ulcers. Then misoprostol 200 microg 4 times a day was administered instead of PPIs for 8 weeks. When the patients could not tolerate misoprostol as a result of side effects, they received another 8 weeks of PPI therapy.
  
  
  RESULTS
  Capsule endoscopy performed after 8 weeks of PPI treatment identified red spots and mucosal breaks in 100% (11/11) and 90.9% (10/11) of patients, respectively. In 7 patients who completed the study protocol, misoprostol significantly decreased the median number of red spots and mucosal breaks, with complete disappearance of mucosal breaks in 4 patients. Intestinal lesions tended not to heal in 3 patients who discontinued misoprostol.
  
  
  CONCLUSIONS
  Low-dose enteric-coated aspirin frequently damages the small intestine, and misoprostol is effective in the treatment of aspirin-induced enteropathy.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan. watanabet@med.osaka-cu.ac.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugimori
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Kameda
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Machida
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Okazaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Oshitani
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects*; D053704:Capsule Endoscopy; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D013608:Tablets, Enteric-Coated / Q000009:adverse effects*; D016896:Treatment Outcome; D014456:Ulcer / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000897:Anti-Ulcer Agents; D013608:Tablets, Enteric-Coated; D016595:Misoprostol; D001241:Aspirin