title: Proximal predominance of small bowel injury associated with uncoated low-dose aspirin therapy: a video capsule study in chronic users.
abstract: OBJECTIVE
  Only a limited number of studies have evaluated the small intestinal damage associated with chronic low-dose aspirin (LDA) therapy. We assessed, using capsule endoscopy, the prevalence and the characteristics of small bowel damage in chronic LDA users compared with patients taking an anticoagulant (AC) and those taking no antithrombotic drugs.
  
  
  METHODS
  We retrospectively reviewed 75 capsule endoscopy recordings from three groups of patients with unexplained iron-deficient anemia: 28 patients receiving LDA, 15 receiving an AC, and 32 not receiving any antithrombotic drug. The severity and location of small intestinal mucosal breaks were assessed in a blinded manner by two endoscopists.
  
  
  RESULTS
  All LDA users received uncoated aspirin. The number of small bowel mucosal breaks in patients receiving LDA (median 1, extremes 0-125) was significantly higher than that in those taking an AC (0, 0-1) (P=0.0005) or no antithrombotic drugs (0, 0-23) (P<0.0001). The prevalence of patients with mucosal breaks was higher in the LDA group (71.4%) than in the AC group (20%, P=0.001) and the control group (12.5%, P=0.000005). Mucosal breaks in LDA users were predominant in the first tertile of the small bowel. The difference between groups was significant only for mucosal breaks located in the first tertile (P<0.0001).
  
  
  CONCLUSIONS
  About two-thirds of uncoated LDA chronic users with anemia have mucosal breaks in the small bowel. These lesions are predominant in the proximal part, suggesting a topical toxic effect of uncoated LDA.
authors.affiliation: Department of aHepato-Gastroenterology bCardiology, Reims University Hospital, Reims, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Ehrhard
authors.forename: Pierre
authors.initials: P
authors.lastname: Nazeyrollas
authors.forename: Hedia
authors.initials: H
authors.lastname: Brixi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Heurgue-Berlot
authors.forename: Gérard
authors.initials: G
authors.lastname: Thiéfin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D053704:Capsule Endoscopy; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced*; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology; D007421:Intestine, Small / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014456:Ulcer / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D001241:Aspirin