title: Upper gastrointestinal lesions in patients receiving clopidogrel anti-platelet therapy.
abstract: OBJECTIVE
  Clopidogrel is associated with a high incidence of upper gastrointestinal bleeding in high-risk patients. However, the characteristic upper gastrointestinal lesions in symptomatic clopidogrel users remain unclear. The aims of this study were to investigate the characteristics of endoscopic findings in clopidogrel users undergoing endoscopy for upper gastrointestinal symptoms and to compare the clinical characteristics and upper gastrointestinal lesions between symptomatic clopidogrel and aspirin users.
  
  
  METHODS
  This observational study included 215 consecutive patients receiving clopidogrel (n=106) or low-dose aspirin (n=109) therapy who underwent endoscopy for dyspeptic symptoms. The upper gastrointestinal lesions were carefully assessed, and a complete medical history was obtained by a standard questionnaire.
  
  
  RESULTS
  The frequencies of hemorrhagic spots, erosions and peptic ulcers in the symptomatic clopidogrel users were 25%, 39% and 39%, respectively. Among the peptic ulcer patients on clopidogrel therapy, the distributions of ulcers were 78%, 5% and 17% in the stomach, duodenum and both, respectively. Compared with the aspirin group, the clopidogrel group was older and had higher frequencies of past ulcer history and past gastrointestinal bleeding history in their clinical characteristics. By contrast, the clopidogrel users had a lower prevalence of active Helicobacter pylori infection than aspirin users (17% vs. 35%, respectively, p=0.007). Regarding to the endoscopic findings, the clopidogrel users had higher frequencies of hemorrhagic spots (25% vs. 10%) and peptic ulcer (39% vs. 24%) than aspirin users (p=0.004 and 0.027, respectively).
  
  
  CONCLUSIONS
  Most peptic ulcers in clopidogrel users are located in the stomach. The frequencies of hemorrhagic spots and peptic ulcers in symptomatic clopidogrel users are higher than those in symptomatic aspirin users.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Tzung-Jiun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.forename: Huay-Min
authors.initials: HM
authors.lastname: Wang
authors.forename: Kung-Hung
authors.initials: KH
authors.lastname: Lin
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Wang
authors.forename: Shiuh-Nan
authors.initials: SN
authors.lastname: Chang
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
authors.forename: Shin-Hung
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Hung-Ru
authors.initials: HR
authors.lastname: Huang
authors.forename: Ching-Huang
authors.initials: CH
authors.lastname: Lin
authors.forename: Feng-Woei
authors.initials: FW
authors.lastname: Tsay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects; D000077144:Clopidogrel; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin