Protons pump inhibitor treatment and lower gastrointestinal bleeding: Balancing risks and benefits

World Journal of Gastroenterology

Volumn 22, Issue 48, 2016, Pages 10477-10481

  Lué, Alberto ^a,b   Lanas, Angel ^a,b,c,d  

^a HOSPITAL CLÍNICO UNIVERSITARIO LOZANO BLESA   (Spain)

^b INSTITUTO DE INVESTIGACIÓN SANITARIA ARAGÓN IIS ARAGÓN   (Spain)

^c UNIVERSITY OF ZARAGOZA   (Spain)

^d INSTITUTO DE SALUD CARLOS III   (Spain)

Author keywords

Lower gastrointestinal bleeding; Nonsteroidal anti inflammatory drugs; Proton pump inhibitor; Small bowel

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT; CELECOXIB; NONSTEROID ANTIINFLAMMATORY AGENT; PLACEBO; PROBIOTIC AGENT; PROTON PUMP INHIBITOR; RABEPRAZOLE; VSL3;

CLINICAL TRIAL (TOPIC); COMORBIDITY; DIGESTIVE SYSTEM INJURY; DRUG EFFICACY; ENTEROPATHY; GASTROINTESTINAL HEMORRHAGE; HEALTH CARE UTILIZATION; HIGH RISK PATIENT; HOSPITALIZATION; HUMAN; INTESTINE FLORA; INTESTINE INJURY; LOW DRUG DOSE; MORTALITY; PATHOGENESIS; PRESCRIPTION; REVIEW; RISK BENEFIT ANALYSIS; AGE; AGED; CHEMICALLY INDUCED; DRUG EFFECTS; INAPPROPRIATE PRESCRIBING; LOWER GASTROINTESTINAL TRACT; PREVENTION AND CONTROL; RISK ASSESSMENT; RISK FACTOR; UPPER GASTROINTESTINAL TRACT;

AGE FACTORS; AGED; ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL; ANTICOAGULANTS; ASPIRIN; GASTROINTESTINAL HEMORRHAGE; GASTROINTESTINAL MICROBIOME; HUMANS; INAPPROPRIATE PRESCRIBING; LOWER GASTROINTESTINAL TRACT; PROBIOTICS; PROTON PUMP INHIBITORS; RISK ASSESSMENT; RISK FACTORS; UPPER GASTROINTESTINAL TRACT;

EID: 85008217130     PISSN: 10079327     EISSN: 22192840     Source Type: Journal    
DOI: 10.3748/wjg.v22.i48.10477     Document Type: Review

References (36)

1. Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FK, Furberg CD, Johnson DA, Mahaffey KW, Quigley EM. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008; 118: 1894-1909 [PMID: 18836135 DOI: 10.1161/circulationaha.108.191087]
2. Scarpignato C, Lanas A, Blandizzi C, Lems WF, Hermann M, Hunt RH. Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis-an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC Med 2015; 13: 55 [PMID: 25857826 DOI: 10.1186/s12916-015-0285-8]
3. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, García S, Bujanda L, Calvet X, Ponce J, Perez-Aísa Á, Castro M, Muñoz M, Sostres C, García-Rodríguez LA. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal antiinflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol 2015; 13: 906-912.e2 [PMID: 25460554 DOI: 10.1016/j.cgh.2014.11.007]
4. Lanas A, Sostres C. PPI therapy. The small bowel, low-dose aspirin and PPIs-should we be concerned Nat Rev Gastroenterol Hepatol 2014; 11: 458-460 [PMID: 25001974 DOI: 10.1038/nrgastro.2014.120]
5. Nagata N, Niikura R, Aoki T, Sakurai T, Moriyasu S, Shimbo T, Sekine K, Okubo H, Watanabe K, Yokoi C, Yanase M, Akiyama J, Uemura N. Effect of proton-pump inhibitors on the risk of lower gastrointestinal bleeding associated with NSAIDs, aspirin, clopidogrel, and warfarin. J Gastroenterol 2015; 50: 1079-1086 [PMID: 25700638 DOI: 10.1007/s00535-015-1055-2]
6. Washio E, Esaki M, Maehata Y, Miyazaki M, Kobayashi H, Ishikawa H, Kitazono T, Matsumoto T. Proton Pump Inhibitors Increase Incidence of Nonsteroidal Anti-Inflammatory Drug-Induced Small Bowel Injury: A Randomized, Placebo-Controlled Trial. Clin Gastroenterol Hepatol 2016; 14: 809-815.e1 [PMID: 26538205 DOI: 10.1016/j.cgh.2015.10.022]
7. Watanabe T, Sugimori S, Kameda N, Machida H, Okazaki H, Tanigawa T, Watanabe K, Tominaga K, Fujiwara Y, Oshitani N, Higuchi K, Arakawa T. Small bowel injury by low-dose entericcoated aspirin and treatment with misoprostol: a pilot study. Clin Gastroenterol Hepatol 2008; 6: 1279-1282 [PMID: 18995219 DOI: 10.1016/j.cgh.2008.06.021]
8. Endo H, Sakai E, Taniguchi L, Kessoku T, Komiya Y, Ezuka A, Kawamura H, Taguri M, Higurashi T, Ohkubo H, Yamada E, Takahashi H, Inamori M, Maeda S, Sakaguchi T, Hata Y, Nagase H, Nakajima A. Risk factors for small-bowel mucosal breaks in chronic low-dose aspirin users: data from a prospective multicenter capsule endoscopy registry. Gastrointest Endosc 2014; 80: 826-834 [PMID: 24830581 DOI: 10.1016/j.gie.2014.03.024]
9. Casado Arroyo R, Polo-Tomas M, Roncalés MP, Scheiman J, Lanas A. Lower GI bleeding is more common than upper among patients on dual antiplatelet therapy: long-term follow-up of a cohort of patients commonly using PPI co-therapy. Heart 2012; 98: 718-723 [PMID: 22523056 DOI: 10.1136/heartjnl-2012-301632]
10. Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Zlotnick S, Fort JG. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 2005; 3: 133-141 [PMID: 15704047]
11. Lanas A, García-Rodríguez LA, Arroyo MT, Gomollón F, Feu F, González-Pérez A, Zapata E, Bástida G, Rodrigo L, Santolaria S, Güell M, de Argila CM, Quintero E, Borda F, Piqué JM. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut 2006; 55: 1731-1738 [PMID: 16687434 DOI: 10.1136/gut.2005.080754]
12. Lanas A, García-Rodríguez LA, Polo-Tomás M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, Perez-Gisbert J, Bujanda L, Castro M, Muñoz M, Rodrigo L, Calvet X, Del-Pino D, Garcia S. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol 2009; 104: 1633-1641 [PMID: 19574968 DOI: 10.1038/ajg.2009.164]
13. Lanas A, García-Rodríguez LA, Polo-Tomás M, Ponce M, Quintero E, Perez-Aisa MA, Gisbert JP, Bujanda L, Castro M, Muñoz M, Del-Pino MD, Garcia S, Calvet X. The changing face of hospitalisation due to gastrointestinal bleeding and perforation. Aliment Pharmacol Ther 2011; 33: 585-591 [PMID: 21205256 DOI: 10.1111/j.1365-2036.2010.04563.x]
14. Smecuol E, Pinto Sanchez MI, Suarez A, Argonz JE, Sugai E, Vazquez H, Litwin N, Piazuelo E, Meddings JB, Bai JC, Lanas A. Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment. Clin Gastroenterol Hepatol 2009; 7: 524-529 [PMID: 19249402 DOI: 10.1016/j.cgh.2008.12.019]
15. Endo H, Higurashi T, Hosono K, Sakai E, Sekino Y, Iida H, Sakamoto Y, Koide T, Takahashi H, Yoneda M, Tokoro C, Inamori M, Abe Y, Nakajima A. Efficacy of Lactobacillus casei treatment on small bowel injury in chronic low-dose aspirin users: a pilot randomized controlled study. J Gastroenterol 2011; 46: 894-905 [PMID: 21556830 DOI: 10.1007/s00535-011-0410-1]
16. Montalto M, Gallo A, Curigliano V, D'Onofrio F, Santoro L, Covino M, Dalvai S, Gasbarrini A, Gasbarrini G. Clinical trial: the effects of a probiotic mixture on non-steroidal anti-inflammatory drug enteropathy-a randomized, double-blind, cross-over, placebo-controlled study. Aliment Pharmacol Ther 2010; 32: 209-214 [PMID: 20384610 DOI: 10.1111/j.1365-2036.2010.04324.x]
17. Wallace JL, Syer S, Denou E, de Palma G, Vong L, McKnight W, Jury J, Bolla M, Bercik P, Collins SM, Verdu E, Ongini E. Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology 2011; 141: 1314-1322 [PMID: 21745447 DOI: 10.1053/j.gastro.2011.06.075]
18. Petruzzelli M, Vacca M, Moschetta A, Cinzia Sasso R, Palasciano G, van Erpecum KJ, Portincasa P. Intestinal mucosal damage caused by non-steroidal anti-inflammatory drugs: role of bile salts. Clin Biochem 2007; 40: 503-510 [PMID: 17321514 DOI: 10.1016/j.clinbiochem.2007.01.015]
19. Takeuchi K, Tanaka A, Kato S, Amagase K, Satoh H. Roles of COX inhibition in pathogenesis of NSAID-induced small intestinal damage. Clin Chim Acta 2010; 411: 459-466 [PMID: 20074562 DOI: 10.1016/j.cca.2009.12.026]
20. Blackler RW, Gemici B, Manko A, Wallace JL. NSAIDgastroenteropathy: new aspects of pathogenesis and prevention. Curr Opin Pharmacol 2014; 19: 11-16 [PMID: 24929967 DOI: 10.1016/j.coph.2014.05.008]
21. Lanas A, Scarpignato C. Microbial flora in NSAID-induced intestinal damage: a role for antibiotics Digestion 2006; 73 Suppl 1: 136-150 [PMID: 16498262 DOI: 10.1159/000089789]
22. Sostres C, Lanas A. Epidemiology of Low Dose Aspirin Damage in the Lower Gastrointestinal Tract. Curr Pharm Des 2015; 21: 5094-5100 [PMID: 26369682]
23. Chan FK, Leung Ki EL, Wong GL, Ching JY, Tse YK, Au KW, Wu JC, Ng SC. Risks of Bleeding Recurrence and Cardiovascular Events With Continued Aspirin Use After Lower Gastrointestinal Hemorrhage. Gastroenterology 2016; 151: 271-277 [PMID: 27130815 DOI: 10.1053/j.gastro.2016.04.013]
24. Chan FK, Lanas A, Scheiman J, Berger MF, Nguyen H, Goldstein JL. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 2010; 376: 173-179 [PMID: 20638563 DOI: 10.1016/ s0140-6736(10)60673-3]
25. Lanas A. We Are Using Too Many PPIs, and We Need to Stop: A European Perspective. Am J Gastroenterol 2016; 111: 1085-1086 [PMID: 27166129 DOI: 10.1038/ajg.2016.166]
26. Lanas A, Polo-Tomás M, Casado-Arroyo R. The aspirin cardiovascular/ gastrointestinal risk calculator-a tool to aid clinicians in practice. Aliment Pharmacol Ther 2013; 37: 738-748 [PMID: 23413984 DOI: 10.1111/apt.12240]
27. Kojima Y, Takeuchi T, Ota K, Harada S, Edogawa S, Narabayashi K, Nouda S, Okada T, Kakimoto K, Kuramoto T, Inoue T, Higuchi K. Effect of long-term proton pump inhibitor therapy and healing effect of irsogladine on nonsteroidal anti-inflammatory drug-induced small-intestinal lesions in healthy volunteers. J Clin Biochem Nutr 2015; 57: 60-65 [PMID: 26236102 DOI: 10.3164/jcbn.15-32]
28. Niwa Y, Nakamura M, Ohmiya N, Maeda O, Ando T, Itoh A, Hirooka Y, Goto H. Efficacy of rebamipide for diclofenac-induced small-intestinal mucosal injuries in healthy subjects: a prospective, randomized, double-blinded, placebo-controlled, cross-over study. J Gastroenterol 2008; 43: 270-276 [PMID: 18458842 DOI: 10.1007/s00535-007-2155-4]
29. Kurata S, Nakashima T, Osaki T, Uematsu N, Shibamori M, Sakurai K, Kamiya S. Rebamipide protects small intestinal mucosal injuries caused by indomethacin by modulating intestinal microbiota and the gene expression in intestinal mucosa in a rat model. J Clin Biochem Nutr 2015; 56: 20-27 [PMID: 25834302 DOI: 10.3164/jcbn.14-67]
30. Kurokawa S, Katsuki S, Fujita T, Saitoh Y, Ohta H, Nishikawa K, Sato Y, Sato Y, Ohira K, Yamada M, Kato M. A randomized, double-blinded, placebo-controlled, multicenter trial, healing effect of rebamipide in patients with low-dose aspirin and/or nonsteroidal anti-inflammatory drug induced small bowel injury. J Gastroenterol 2014; 49: 239-244 [PMID: 23595613 DOI: 10.1007/ s00535-013-0805-2]
31. Watanabe T, Takeuchi T, Handa O, Sakata Y, Tanigawa T, Shiba M, Naito Y, Higuchi K, Fujimoto K, Yoshikawa T, Arakawa T. A multicenter, randomized, double-blind, placebo-controlled trial of high-dose rebamipide treatment for low-dose aspirin-induced moderate-to-severe small intestinal damage. PLoS One 2015; 10: e0122330 [PMID: 25874951 DOI: 10.1371/journal.pone.0122330]
32. Isomura Y, Yamaji Y, Yamada A, Watanabe Y, Suzuki H, Kobayashi Y, Yoshida S, Watabe H, Hirata Y, Yoshida H, Koike K. Irsogladine improves small-intestinal injuries in regular users of nonsteroidal anti-inflammatory drugs. Gastrointest Endosc 2014; 80: 118-125 [PMID: 24518124 DOI: 10.1016/j.gie.2013.12.030]
33. Kuramoto T, Umegaki E, Nouda S, Narabayashi K, Kojima Y, Yoda Y, Ishida K, Kawakami K, Abe Y, Takeuchi T, Inoue T, Murano M, Tokioka S, Higuchi K. Preventive effect of irsogladine or omeprazole on non-steroidal anti-inflammatory drug-induced esophagitis, peptic ulcers, and small intestinal lesions in humans, a prospective randomized controlled study. BMC Gastroenterol 2013; 13: 85 [PMID: 23672202 DOI: 10.1186/1471-230x-13-85]
34. Umegaki E, Kuramoto T, Kojima Y, Nouda S, Ishida K, Takeuchi T, Inoue T, Tokioka S, Higuchi K. Geranylgeranylacetone, a gastromucoprotective drug, protects against NSAID-induced esophageal, gastroduodenal and small intestinal mucosal injury in healthy subjects: A prospective randomized study involving a comparison with famotidine. Intern Med 2014; 53: 283-290 [PMID: 24531083]
35. Xiong L, Huang X, Li L, Yang X, Liang L, Zhan Z, Ye Y, Chen M. Geranylgeranylacetone protects against small-intestinal injuries induced by diclofenac in patients with rheumatic diseases: a prospective randomized study. Dig Liver Dis 2015; 47: 280-284 [PMID: 25660821 DOI: 10.1016/j.dld.2015.01.005]
36. Ganesh BP, Versalovic J. Luminal Conversion and Immunoregulation by Probiotics. Front Pharmacol 2015; 6: 269 [PMID: 26617521 DOI: 10.3389/fphar.2015.00269]