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Sun X, Wang F, Liu J, Wu L, Wang Z, Chen X, Wang M, Zeng Q. Risk factors for small-intestinal mucosal breaks beyond aspirin. J Gastroenterol Hepatol 2022; 37:1596-1602. [PMID: 35642270 DOI: 10.1111/jgh.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM There remains lots of unknowns for small intestinal mucosal breaks (SIMBs). The application of magnetic controlled capsule endoscope (MCCE) may provide a better understanding of SIMBs. The aim of our study was to investigate the prevalence and characteristics of SIMBs in the general population as well as risk factors for SIMBs other than aspirin. METHODS Clinical data on individuals who visited our institute between January 2019 and February 2021 for MCCE examination as a health check were collected and analyzed retrospectively. All study participants must have completed the small bowel inspection. Multivariate analysis was employed to reveal the independent risk factors for SIMBs. RESULTS A total of 1599 participants, 103 of whom were aspirin users, were finally included. The prevalence of SIMBs was 8.3% (132/1599) in all participants, with 36.9% (38/103) in aspirin users and 6.3% (94/1496) in non-aspirin users. The multivariate analysis showed that in addition to aspirin (OR: 6.17, 95% CI: 3.25-11.58), obesity (OR: 2.30, 95% CI: 1.38-3.92) and smoking (OR: 1.85, 95% CI: 1.56-3.20) were also independent risk factors for SIMBs. Jejunum involvement was more common in aspirin users (20/38, 52.6%), while ilium involvement was more common in non-aspirin users (58/94, 61.7%). Moderate SIMBs (erosions) were more common in aspirin users (17/38, 44.7%), while severe SIMBs (large erosions/ulcers) were more common in non-aspirin users (17/94, 18.1%). CONCLUSIONS The risk factors for SIMBs include aspirin as well as smoking and obesity, and the severity and distributive features of SIMBs differ between aspirin users and non-aspirin users.
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Affiliation(s)
- Xi Sun
- Department of Gastroenterology and Hepatology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Fei Wang
- Department of Health Management Institution, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jing Liu
- Department of Gastroenterology and Hepatology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Lili Wu
- Department of Gastroenterology and Hepatology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zhiqiang Wang
- Department of Gastroenterology and Hepatology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiao Chen
- Department of Gastroenterology and Hepatology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ming Wang
- Department of Gastroenterology and Hepatology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Qang Zeng
- Department of Health Management Institution, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Watanabe T, Fujiwara Y, Chan FKL. Current knowledge on non-steroidal anti-inflammatory drug-induced small-bowel damage: a comprehensive review. J Gastroenterol 2020; 55:481-495. [PMID: 31865463 PMCID: PMC7188723 DOI: 10.1007/s00535-019-01657-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 02/04/2023]
Abstract
Recent advances in small-bowel endoscopy such as capsule endoscopy have shown that non-steroidal anti-inflammatory drugs (NSAIDs) frequently damage the small intestine, with the prevalence rate of mucosal breaks of around 50% in chronic users. A significant proportion of patients with NSAIDs-induced enteropathy are asymptomatic, but some patients develop symptomatic or complicated ulcers that need therapeutic intervention. Both inhibition of prostaglandins due to the inhibition of cyclooxygenases and mitochondrial dysfunction secondary to the topical effect of NSAIDs play a crucial role in the early process of injury. As a result, the intestinal barrier function is impaired, which allows enterobacteria to invade the mucosa. Gram-negative bacteria and endogenous molecules coordinate to trigger inflammatory cascades via Toll-like receptor 4 to induce excessive expression of cytokines such as tumor necrosis factor-α and to activate NLRP3 inflammasome, a multiprotein complex that processes pro-interleukin-1β into its mature form. Finally, neutrophils accumulate in the mucosa, resulting in intestinal ulceration. Currently, misoprostol is the only drug that has a proven beneficial effect on bleeding small intestinal ulcers induced by NSAIDs or low-dose aspirin, but its protection is insufficient. Therefore, the efficacy of the combination of misoprostol with other drugs, especially those targeting the innate immune system, should be assessed in the next step.
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Affiliation(s)
- Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Francis K L Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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Rimbaş M, Zahiu DCM, Voiosu AM, Voiosu TA, Zlate AAM, Dinu R, Galasso D, Minelli Grazioli L, Campanale M, Barbaro F, Mateescu BR, Busuioc B, Iordache T, Dolofan O, Popescu AM, Balaban VD, Raducan MM, Spada C, Băicuş CR, Costamagna G. Usefulness of virtual chromoendoscopy in the evaluation of subtle small bowel ulcerative lesions by endoscopists with no experience in videocapsule. Endosc Int Open 2016; 4:E508-14. [PMID: 27227106 PMCID: PMC4874791 DOI: 10.1055/s-0042-106206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/29/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS In videocapsule endoscopy examination (VCE), subtle variations in mucosal hue or pattern such as those seen in ulcerations can be difficult to detect, depending on the experience of the reader. Our aim was to test whether virtual chromoendoscopy (VC) techniques, designed to enhance the contrast between the lesion and the normal mucosa, could improve the characterization of ulcerative mucosal lesions. PATIENTS AND METHODS Fifteen trainees or young gastroenterologists with no experience in VCE were randomly assigned to evaluate 250 true ulcerative and 100 false ulcerative, difficult-to-interpret small bowel lesions, initially as white light images (WLI) and then, in a second round, with the addition of one VC setting or again as WLI, labeling them as real lesions or artifacts. RESULTS On the overall image evaluation, an improvement in lesion characterization was observed by adding any chromoendoscopy setting, especially Blue mode and FICE 1, with increases in accuracy of 13 % [95 %CI 0.8, 25.3] and 7.1 % [95 %CI - 17.0, 31.3], respectively. However, when only false ulcerative images were considered, with the same presets (Blue mode and FICE 1), there was a loss in accuracy of 10.7 % [95 %CI - 10.9, 32.3] and 7.3 % [95 %CI - 1.3, 16.0], respectively. The interobserver agreement was poor for both readings. CONCLUSIONS VC helps beginner VCE readers correctly categorize difficult-to-interpret small bowel mucosal ulcerative lesions. However, false lesions tend to be misinterpreted as true ulcerative with the same presets. Therefore care is advised in using VC especially under poor bowel preparation.
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Affiliation(s)
- Mihai Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | | | - Andrei Mihai Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | - Theodor Alexandru Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | | | - Roxana Dinu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | | | | | - Bogdan Radu Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | - Bogdan Busuioc
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Tiberiu Iordache
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Oana Dolofan
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Mircea Mihai Raducan
- Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
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Rimbaş M, Negreanu L, Ciobanu L, Benguş A, Spada C, Băicuş CR, Costamagna G. Is virtual chromoendoscopy useful in the evaluation of subtle ulcerative small-bowel lesions detected by video capsule endoscopy? Endosc Int Open 2015; 3:E615-20. [PMID: 26716122 PMCID: PMC4683137 DOI: 10.1055/s-0034-1393063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The identification of subtle small-bowel mucosal lesions by video capsule endoscopy (VCE) can be challenging. Virtual chromoendoscopy techniques, based on narrowing the bandwidth of conventional white light endoscopic imaging (WLI), were developed to improve the analysis of mucosal patterns. However, data on the already-implemented Flexible spectral Imaging (or Fujinon Intelligent) Color Enhancement (FICE) software application in VCE are limited. MATERIALS AND METHODS An evaluation of 250 difficult-to-interpret small-bowel ulcerative and 50 artifact lesions selected from 64 VCE recordings was conducted by four experienced VCE readers in two steps: initially as WLI, then with the addition of all available virtual chromoendoscopy pre-sets (FICE 1, 2, and 3 and Blue mode). The readers labeled them as real or false ulcerative lesions and rated the usefulness of each of the pre-sets. RESULTS Between the first (WLI-only) and second (virtual chromoendoscopy-aided) readings, in terms of accuracy there was a global 16.5 % (95 % confidence interval [95 %CI] 13.6 - 19.4 %) improvement (P < 0.001), derived from a 22 % [95 %CI 18.9 - 25.1 %] improvement in the evaluation of true ulcerative images (P < 0.001) and an 11 % (95 %CI 4.1 - 17.7 %) decrease in the evaluation of false ulcerative ones (P = 0.003). The FICE 1 and 2 pre-sets were rated as most useful. CONCLUSION The application of virtual chromoendoscopy for VCE is useful to better categorize difficult-to-interpret small-bowel mucosal ulcerative lesions. However, care must be taken, and individual images should be evaluated only as part of a sequence in a recording because the technology can also mistakenly guide to the incorrect interpretation of artifacts as ulcerative lesions.
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Affiliation(s)
- Mihai Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Corresponding author Mihai Rimbaş, MD, PhD Gastroenterology DepartmentClinic of Internal Medicine Colentina Clinical Hospital19-21 Ştefan cel Mare Street 020125, Bucharest Romania+40-318-162-376
| | - Lucian Negreanu
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Internal Medicine and Gastroenterology Department, University Emergency Hospital, Bucharest, Romania
| | - Lidia Ciobanu
- Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Benguş
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristiano Spada
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristian Răsvan Băicuş
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,Clinical Research Unit RECIF (Réseau d’Epidémiologie Clinique International Francophone), Bucharest, Romania
| | - Guido Costamagna
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Liu CC, Duan ZT, Yuan FC, Jiang ZD, Wang ZB, Yang XB, Wang JS, Zhang ZY. Protective effect of rabamipide on non-steroid anti-inflammatory drug induced enteropathy in rats. Shijie Huaren Xiaohua Zazhi 2015; 23:3838-3845. [DOI: 10.11569/wcjd.v23.i24.3838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of rabamipide on non-steroid anti-inflammatory drug (NSAID) induced enteropathy in rats and the possible mechanism.
METHODS: Thirty male Sprague-Dawley rats were randomized into three groups: a control group, a diclofenac induced injury group, and a rabamipide pretreatment group. Intestinal injury was induced in rats of the diclofenac induced injury group and rabamipide pretreatment group by intragastric administration of diclofenac (7.5 mg/kg) once per day for continuous 4 d. The rabamipide pretreatment group was pretreated with rabamipide 100 mg/(kg•d) orally once daily 1 h before the administration of diclofenac. The control group received 0.9% NaCl by gavage during the same period. All the rats were sacrificed on the 4th day. Small intestinal injuries were assessed for histopathological damage and macroscopic injury and recorded as corresponding scores. Immunohistochemistry and Western blot were used to detect the distribution and expression of intestinal epithelial tight junction protein occludin. The expression of ERK, p38, phosphorylated ERK (p-ERK) and phosphorylated p38 (p-p38) was determined by Western blot.
RESULTS: Compared with the control group, histopathological and macroscopic scores of intestinal damage were significantly increased in the diclofenac induced injury group (P < 0.05). Intestinal damage scores in the rabamipide pretreatment group were significantly decreased compared with those in the diclofenac induced injury group (P < 0.05). Compared with the control group, expression of occludin in the diclofenac induced injury group was decreased significantly (P < 0.05), while that in the rabamipide pretreatment group increased significantly compared with the diclofenac induced injury group (P < 0.05). Significant activation of ERK and p38 was seen in the diclofenac induced injury group compared with the control group (P < 0.05), and pretreatment with rabamipide significantly inhibited the activation of ERK and p38 compared with the diclofenac induced injury group (P < 0.05).
CONCLUSION: Rabamipide has a protective effect on NSAID induced enteropathy in rats, probably by increasing the expression of occludin protein and inhibiting the activation of ERK as well as p38 signaling pathways.
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Jakobsen AK, Jacobsson LTH, Patschan O, Askling J, Kristensen LE. Is nephrolithiasis an unrecognized extra-articular manifestation in ankylosing spondylitis? A prospective population-based Swedish national cohort study with matched general population comparator subjects. PLoS One 2014; 9:e113602. [PMID: 25423471 PMCID: PMC4244108 DOI: 10.1371/journal.pone.0113602] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/25/2014] [Indexed: 01/08/2023] Open
Abstract
Background Ankylosing spondylitis (AS) is associated with several extra-articular manifestations. Nephrolithiasis (NL) has not been recognized as one of those, however, several factors known to increase the risk of NL are at play in AS patients. The objective was to estimate rates and predictors of NL in Swedish patients with AS compared to the general population. Methods and Findings We performed a prospective population-based nationwide cohort study based on linkage of data from Swedish registries. 8,572 AS patients were followed for 49,258 person-years (py) and 39,639 matched general population comparators were followed for 223,985 py. Patients were followed prospectively together with comparator subjects from January 2001 through December 2009. The first occurrence of NL during follow-up was the primary outcome. Hazard Ratios (HR) were used to compare these rates adjusting for comorbidities and treatment, and to assess predictors for NL. Mean age at study entry was 46 years (inter quartile range 36–56 years), 65% were males. Based on 250 vs. 466 NL events, the adjusted HR of NL in AS patients was 2.1 (95%CI 1.8 to 2.4). Predictors of NL within the AS group included prior diagnosis of inflammatory bowel disease (IBD) (HR 2.3; 95%CI 1.7 to 3.3), prior diagnosis of NL (HR 16.4; 95%CI 11.5 to 23.4), and patients receiving anti-TNF treatment (HR 1.6; 95%CI 1.2 to 2.1). Male sex was a risk factor for NL both in AS patients and in the general population. Limitations The risk for residual confounding and inability to study the chemical nature of NL were considered the main limitations of the study. Conclusions Patients with AS are at increased risk of NL, which may be considered a novel extra-articular manifestation. Previous history of NL, IBD, AS disease severity and male sex were identified as predictors of NL in AS.
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Affiliation(s)
| | - Lennart T. H. Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Lund University, Malmö, Sweden
| | - Oliver Patschan
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Johan Askling
- Clinical Epidemiology Unit and Rheumatology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Lars Erik Kristensen
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- The Parker Institute and Department of Rheumatology; Frederiksberg and Bispebjerg, Denmark
- * E-mail:
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Yamamoto A, Itoh T, Nasu R, Nishida R. Sodium alginate ameliorates indomethacin-induced gastrointestinal mucosal injury via inhibiting translocation in rats. World J Gastroenterol 2014; 20:2641-2652. [PMID: 24627600 PMCID: PMC3949273 DOI: 10.3748/wjg.v20.i10.2641] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/20/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of sodium alginate (AL-Na) on indomethacin-induced small intestinal lesions in rats.
METHODS: Gastric injury was assessed by measuring ulcerated legions 4 h after indomethacin (25 mg/kg) administration. Small intestinal injury was assessed by measuring ulcerated legions 24 h after indomethacin (10 mg/kg) administration. AL-Na and rebamipide were orally administered. Myeloperoxidase activity in the stomach and intestine were measured. Microvascular permeability, superoxide dismutase content, glutathione peroxidase activity, catalase activity, red blood cell count, white blood cell count, mucin content and enterobacterial count in the small intestine were measured.
RESULTS: AL-Na significantly reduced indomethacin-induced ulcer size and myeloperoxidase activity in the stomach and small intestine. AL-Na prevented increases in microvascular permeability, superoxide dismutase content, glutathione peroxidase activity and catalase activity in small intestinal injury induced by indomethacin. AL-Na also prevented decreases in red blood cells and white blood cells in small intestinal injury induced by indomethacin. Moreover, AL-Na suppressed mucin depletion by indomethacin and inhibited infiltration of enterobacteria into the small intestine.
CONCLUSION: These results indicate that AL-Na ameliorates non-steroidal anti-inflammatory drug-induced small intestinal enteritis via bacterial translocation.
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Treatment of ankylosing spondylitis: a critical appraisal of nonsteroidal anti-inflammatory drugs and corticosteroids. Am J Med Sci 2012; 343:350-2. [PMID: 22543535 DOI: 10.1097/maj.0b013e31825140a7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Treatment of ankylosing spondylitis and related disorders has been revolutionized by the advent of biological therapy, especially tumor necrosis factor-α inhibitors. Nonsteroidal anti-inflammatory drugs, however, remain the first line of treatment. Evidence has accumulated that nonsteroidal anti-inflammatory drug therapy of ankylosing spondylitis and related disorders is effective in controlling several of the clinical manifestations seen in these disorders, particularly pain, physical function and perhaps progressive spinal fusion. What needs to be proven, however, is the long-term safety profile of these drugs.
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