title: Small-bowel mucosal injuries in low-dose aspirin users with obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  To investigate the clinical differences between small intestinal injuries in low-dose aspirin (LDA) users and in non-steroidal anti-inflammatory drug (NSAID) users who were examined by capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB).
  
  
  METHODS
  A total of 181 patients who underwent CE for OGIB were included in this study. Based on clinical records, laboratory data such as hemoglobin levels, major symptoms, underlying diseases, the types and duration of LDA and NSAID use, and endoscopic characteristics of CE were reviewed.
  
  
  RESULTS
  Out of a total of 45 cases of erosive lesions, 27 cases were taking LDA or NSAIDs (7 were on NSAIDs, 9 were on LDA alone, 9 were on LDA and thienopyridine, and 2 were on LDA and warfarin).The prevalence of ulcers or erosion during chronic use of LDA, LDA and the anti-platelet drug thienopyridine (clopidogrel or ticlopidine), and NSAIDs were 64.3%, 80.0%, and 75.0%, respectively. Erosive lesions were observed predominantly in chronic LDA users, while ulcerative lesions were detected mainly in NSAID users. However, concomitant use of thienopyridine such as clopidogrel with LDA increased the proportion of ulcers. The erosive lesions were located in the whole of the small intestine (jejunum and ileum), whereas ulcerative lesions were mainly observed in the ileum (P < 0.05).
  
  
  CONCLUSIONS
  Our CE findings indicate that chronic LDA users and NSAID users show different types and locations of small-bowel mucosal injuries. The concomitant use of anti-platelet drugs with LDA tends to exacerbate the injuries from LDA-type to NSAID-type injuries.
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Iwamoto
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Mizokami
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Shimokobe
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Honda
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ikegami
authors.affiliation: Junichi Iwamoto, Yoshifumi Saito, Koichi Shimokobe, Akira Honda, Tadashi Ikegami, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D053704:Capsule Endoscopy; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D007421:Intestine, Small / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000473:pathology; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced / Q000175:diagnosis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Capsule endoscopy; Low-dose aspirin; Non-steroidal anti-inflammatory drugs; Obscure gastrointestinal bleeding; Small-bowel mucosal injuries