Small Bowel Injury by Low-Dose Enteric-Coated Aspirin and Treatment With Misoprostol: A Pilot Study
Small Bowel Injury by Low-Dose Enteric-Coated Aspirin and Treatment With Misoprostol: A Pilot Study
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DOI：
10.1016/j.cgh.2008.06.021
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发表时间：
2008-11-01
影响因子：
12.6
通讯作者：
Arakawa, Tetsuo
中科院分区：
文献类型：
--
作者：
Watanabe, Toshio;Sugimori, Satoshi;Arakawa, Tetsuo
背景与目的：通过胶囊内窥镜检查，评价小剂量阿司匹林肠溶胶囊对小鼠小肠溃疡形成的影响及米索前列醇对肠道损伤的治疗作用。方法：11例在接受小剂量肠溶阿司匹林治疗期间发生胃溃疡的患者入选研究。他们继续服用阿司匹林治疗，同时服用质子泵抑制剂(PPI)8周来治愈胃溃疡。然后用米索前列醇200 mg/d，4次/d代替PPI，疗程8周。当患者因副作用而不能耐受米索前列醇时，他们再接受8周的PPI治疗。结果：PPI治疗8周后，胶囊内窥镜检查发现100%(11/11)的患者发现红斑，90.9%(10/11)的患者发现粘膜破裂。在完成研究方案的7例患者中，米索前列醇显著减少红斑和粘膜破裂的中位数，4例粘膜破裂完全消失。停用米索前列醇的3例患者肠道病变倾向于不愈合。结论：小剂量肠溶阿司匹林常对小肠造成损害，米索前列醇是治疗阿司匹林所致肠病的有效药物。
Background & Aims: 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 mu g 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.