Akari Isono

Gastroduodenal Mucosal Injury in Patients Taking Low-Dose Aspirin and the Role of Gastric Mucoprotective Drugs: Possible Effect of Rebamipide

The present study was conducted to investigate the prevalence of mucosal injury in patients taking low-dose aspirin in Japan and examine the effect of gastric mucoprotective drugs on aspirin-related gastroduodenal toxicity. We selected 530 patients who had taken low-dose aspirin for 1 month or more after undergoing esophagogastroduodenoscopy from 2005 through 2006 at Teikyo University Hospital, Tokyo, Japan. Endoscopic records were retrospectively reviewed to determine the presence of massive bleeding and mucosal injury (ulcer or erosion). The influence of clinical factors, including co-administration of gastroprotective drugs, was also examined. Hemorrhage was observed in 25 patients (3.7%) and mucosal injury (36.2%) in 192 patients. The presence of Helicobacter pylori antibody was a significant risk factor associated with mucosal injury. Patients taking any gastroprotective drug showed a significantly lower rate of mucosal injury than those not taking these drugs. Patients taking rebamipide concomitantly with proton pump inhibitors or histamine 2 receptor antagonists had mucosal injury less frequently than those taking acid suppressants plus other mucoprotective drugs. In conclusion, these results show the possible gastroprotective effects of rebamipide, suggesting that it may be a good choice in aspirin users with gastroduodenal toxicity that is not suppressed by acid suppressants alone.

Prevalence of erosive esophagitis among Japanese patients taking low-dose aspirin.

Background and Aim:  The risk for erosive esophagitis (EE) with low‐dose aspirin (ASA) remains unknown, especially among Japanese patients. We conducted the present study to compare the risk of EE with that of gastroduodenal mucosal injury among Japanese patients taking ASA.

Prevalence of gastroduodenal mucosal injury in asymptomatic patients taking antiplatelet agents in Japan.

PURPOSE There is little knowledge regarding the prevalence of mucosal injury (MI) in Japanese patients receiving antiplatelet therapy. This study estimated the prevalence of gastroduodenal MI in asymptomatic Japanese patients taking antiplatelet agents and nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS Among patients who underwent an upper gastrointestinal endoscopy at Teikyo University Hospital (Tokyo, Japan), 382 asymptomatic patients taking either low-dose aspirin, ticlopidine, cilostazol, or other NSAIDs and 119 people not taking any of these agents were included. Endoscopic records were evaluated for the presence of MI. RESULTS Aspirin and NSAIDs users showed a higher prevalence of MI than controls (Aspirin, OR = 2.6 (95% CI = 1.4 - 4.9), NSAIDs, 2.9 (1.4 - 4.4)). Concomitant use of aspirin and NSAIDs increased the prevalence of MI (11.2 (2.8 - 44.8)). Ticlopidine and cilostazol were less likely to cause injury than aspirin and other NSAIDs, the difference remained insignificant due to small sample number (ticlopidine, 0.8 (0.2 - 4.0), cilostazol, 1.3 (0.3 - 4.8)). CONCLUSIONS In asymptomatic Japanese patients receiving low-dose aspirin, the prevalence of the gastroduodenal MI was the same as that in patients taking NSAIDs and higher than that in controls.

Inflammatory Bowel Disease in an Elderly Woman After Nivolumab Administration

Inflammatory Bowel Disease in an Elderly Woman After Nivolumab Administration Koichiro Abe;Naohiro Nakamura;Akari Isono;Hikaru Toyota;Hidenori Arai;Koji Saito; American Journal of Gastroenterology

Difference between the Upper and the Lower Gastrointestinal Bleeding in Patients Taking Nonvitamin K Oral Anticoagulants

Nonvitamin K oral anticoagulants (NOACs) sometimes cause hemorrhage, and the gastrointestinal tract is a common site of involvement. However, clinical characteristics of gastrointestinal bleeding (GIB) during NOAC therapy have not been fully elucidated. We studied 658 patients who were prescribed dabigatran, rivaroxaban, or apixaban between April 2011 and November 2015. Medical charts were reviewed to examine whether clinically relevant bleeding (Bleeding Academic Research Consortium criteria type 2 or greater) developed. The incidence of GIB was 2.0%/year, and one-third was from the upper GI. Among all hemorrhagic events, GIB was the most common cause. The extent of bleeding from the GI tract, particularly the upper GI tract, was more serious than bleeding from the other site. Multiple regression analysis showed that both past digestive ulcer and absence of concomitant proton pump inhibitors were significantly associated with the incidence of upper GIB, while concomitant nonsteroidal anti-inflammatory drugs, dual antiplatelets, and past GIB were significant factors regarding lower GIB. GIB was common and serious in patients taking NOACs. Upper GIB tended to become more serious than lower GIB. Proton pump inhibitors seem to be key drugs for preventing upper GIB during NOAC therapy.

Extensive gastric mucosal atrophy is a possible predictor of clinical effectiveness of acotiamide in patients with functional dyspepsia

BACKGROUND Acotiamide is known as an effective agent for functional dyspepsia. However, clinical factors related to its effectiveness have not been fully elucidated, so it is difficult to predict the drugs effectiveness prior to its administration in patients. AIMS The present retrospective study was conducted to examine the relationship between clinical factors and the effectiveness of acotiamide for functional dyspepsia. MATERIALS AND METHODS The study subjects were 149 patients with functional dyspepsia who were prescribed acotiamide. Based on medical records and clinical factors, including endoscopic findings, the effectiveness of acotiamide was investigated. RESULTS Significant clinical factors associated with acotiamides effectiveness were identified. These included postprandial syndrome, concomitant mental disorder, and extensive gastric mucosal atrophy. On multiple regression analysis, extensive gastric mucosal atrophy showed the strongest relationship with the clinical effectiveness of acotiamide; the other significant factor was concomitant mental disorder. CONCLUSION Although the pathophysiology of the relationship between mucosal atrophy and acotiamide remains uncertain, a decrease in hormonal secretion, such as that of ghrelin, may be a possible mechanism.
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Possible Effect of Concomitant Prokinetics and Herbal Medicines against Nausea in Patients Taking Lubiprostone

Background and Aim Lubiprostone is a novel laxative that sometimes causes nausea, but preventive strategies remain unconfirmed. Methods We retrospectively chose 126 patients prescribed lubiprostone from 2013 to 2016. Medical records were reviewed to clarify whether nausea developed after administration of the drug. Background characteristics, including concomitant medicines, were also reviewed. Results The most common adverse symptom was diarrhea (23.8%). Nausea occurred in 16 patients (12.7%). Patients taking either prokinetics or herbal medicines or both were unlikely to develop nausea (p = 0.007). Conclusions Concomitant prokinetics and/or herbal medicines may help alleviate lubiprostone-induced nausea.

Gastrointestinal Ulcerative Nodular Lesions

Gastroenter Question: A 50year-old man was admitted to our hospital with refractory diarrhea. He had suffered from multiple myeloma for 6 years, had undergone umbilical cord blood transplantation 3 months earlier, and was taking tacrolimus for immunomodulation. Fecal culture and Clostridium difficile toxin assay yielded no significant findings. Although antibiotics were administered, symptoms did not improve. Eight days after admission, colonoscopy with minimum preparation revealed multiple ulcerative nodular lesions with elevated margins throughout the colon (Figure A). Similar findings were seen in the stomach (Figure B). What is the diagnosis? Look on page 828 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Differences in Clinical Characteristics between Right- and Left-Sided Colonic Diverticular Hemorrhage

Background: The number of patients with diverticular diseases has recently increased in Japan. Hemorrhage is a common manifestation of colonic diverticulosis, and the most frequent cause of lower gastrointestinal bleeding. Right- (RSD) and left- (LSD) sided diverticula are more predominant in Asian and in non-Asian populations, respectively. This retrospective study investigates differences in the clinical courses of hemorrhages arising from RSD and LSD. Methods: The clinical characteristics of 109 consecutive patients with colonic diverticular hemorrhage (from RSD, n=75; from LSD, n=34) selected from those admitted to Teikyo University Hospital (Tokyo, Japan) between January 2004 and August 2012 were compared. Results: Mean age was slightly lower and males were more predominant in the RSD than in the LSD group. All other background data were similar. Four and two patients in the RSD group required surgical resection and hemostasis using angiography, respectively, whereas none of the patients in the LSD group needed such invasive treatment. Endoscopic hemostasis was achieved in 21 (28%) of 75 and in 5 (14.7%) of 34 patients in the RSD and LSD groups, respectively, although the difference was not significant. The recurrence rates were essentially identical (RSD, 17.3%; LSD, 17.6%). Conclusion: Patients with hemorrhage from RSD tended to be more male-dominant than those from LSD. Serious bleeding is more likely to arise in patients with RSD, and endoscopic hemostasis is one choice of treatment when bleeding is suspected.