Small bowel injury by low-dose enteric-coated aspirin and treatment with misoprostol: a pilot study.
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.
Watanabe
Toshio
T
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan. watanabet@med.osaka-cu.ac.jp
Sugimori
Satoshi
S
Kameda
Natsuhiko
N
Machida
Hirohisa
H
Okazaki
Hirotoshi
H
Tanigawa
Tetsuya
T
Watanabe
Kenji
K
Tominaga
Kazunari
K
Fujiwara
Yasuhiro
Y
Oshitani
Nobuhide
N
Higuchi
Kazuhide
K
Arakawa
Tetsuo
T
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
D000897:Anti-Ulcer Agents; D013608:Tablets, Enteric-Coated; D016595:Misoprostol; D001241:Aspirin