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A new option for treatment of small intestinal mucosal injury induced by low-dose aspirin (LDA)

A new option for treatment of small intestinal mucosal injury induced by low-dose aspirin (LDA)

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-12-01
  • Views:0

(Summary description)

A new option for treatment of small intestinal mucosal injury induced by low-dose aspirin (LDA)

(Summary description)

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-12-01
  • Views:0
Information

 

 Relaisson

  RUILAISHENG

  Aspirin is a non-steroidal anti-inflammatory drug (NSAID) and one of the most widely prescribed drugs in the world. Low-dose aspirin (LDA) is generally used for secondary prevention of cardiovascular and stroke. NSAID (including aspirin) inhibits the activity of cyclooxygenase (COX), thereby inhibiting mucosal prostaglandin (PG) synthesis, reducing endogenous PG, resulting in decreased secretion of intestinal mucus, accompanied by abnormal bowel motility and increased mucosal permeability. Cause microcirculation disorders. At the same time, NSAID dissolves the phospholipids on the mucosal surface, directly damages the mitochondria of endothelial cells, leads to the loss of calcium ions and increases in free radicals, damages the connections between cells, and increases the permeability of the small intestinal mucosa, which leads to damage to the small intestinal mucosa.

  Polyprezinc is a chelate composed of zinc and carnosine. A large number of studies have confirmed that it can protect tight junctions between cells and prevent cell apoptosis, thereby exerting anti-inflammatory and antioxidant effects. Omatsu and other studies believe that polyprezinc protects rat intestinal epithelial (RIE-1) cells from indomethacin-induced apoptosis by blocking the action of reactive oxygen species (ROS). Mahmood et al. reported that carnosine zinc can prevent indomethacin from increasing intestinal permeability caused by indomethacin in healthy volunteers, further confirming that it can play a protective role in the small intestine, and believe that polyprezinc may have the prevention or treatment of NSAID-induced Potential for small intestinal mucosal damage. Therefore, this study adopted a prospective randomized controlled study method to evaluate the effectiveness and safety of polyprezinc in the treatment of small intestinal mucosal damage caused by LDA.

  01

  Research object

  From 2010.5-2011.9, patients who underwent upper gastrointestinal endoscopy or colonoscopy at Hiroshima University Hospital in Japan and who were continuously taking LDA were enrolled.

  standard constrain

  Continuous LDA (100 mg, qd, >3 months);

  did not take antibiotics when entering the group;

  age ≥ 21 years old;

  First capsule (CE) inspection.

  exclusion criteria

  Taking LDA other than non-steroidal anti-inflammatory drugs;

  Inflammatory bowel disease;

  Digestion and absorption dysfunction;

  Use other drugs for the treatment of gastritis, such as misoprostol or rebamipide, within 6 months before joining the group;

  use antibiotics or thyroxine sodium;

  Gastrointestinal stricture or severe adhesion;

  Pregnant or lactating women;

  Severe ulcerative lesions were observed during initial CE,

  There is no small intestinal mucosal injury at the initial CE, and the CE capsule fails to reach the cecum.

  Twenty cases were finally screened, and patients with small intestinal mucosal damage caused by LDA were enrolled in the group.

  02

  research method

  Patients with small bowel damage caused by LDA after the initial CE (n = 20) were randomly divided into polyprezinc (150 mg/day, 4 weeks) group and control group (no polyprezinc treatment). All patients were After 4 weeks, they received CE follow-up to compare the number and characteristics of small intestinal mucosal damage within and between the two groups (Figure 1).

  Figure 1 Flow chart of patient grouping

  ◆ ◆ ◆ ◆

  The definition of small bowel injury caused by LDA is as follows: (1) CE examination found ulcers, erosions or redness and swelling; (2) using LDA for >3 months; (3) excluding Crohn's disease, intestinal tuberculosis and other small bowel diseases. The small intestinal mucosal injury is shown in Figure 2.

  Figure 2. Classification of LDA-induced small intestinal mucosal injury by capsule endoscopy

  A ulcer (depression with albuginea); B erosion (white spots surrounded by a red halo); C redness and swelling lesions (such as red folds, bare areas or red mucosal changes in bleeding spots)

  ◆ ◆ ◆ ◆

  The CE score is determined based on the inflammatory changes in the small intestinal mucosa, which is based on the chorionic appearance, ulcers and stenosis variables of the CE examination. According to the final CE score, the results are divided into: normal or no clinically significant changes (total score <135), mild changes (total score ≥135 but <789), moderate and severe changes (total score ≥790).

  Quantitative data is expressed as the median (range), and categorical data is expressed as the number of each group. Fisher's exact test was used to analyze the gender ratio, the use of anti-ulcer drugs, the indications of LDA treatment, and the differences between the three-quantile CE scores; the Wilcoxon rank sum test was used to analyze the initial CE and subsequent CE in ulcers/erosions and redness The number of lesions and the intra-group differences between CE scores; JMP-J software analysis, P <0.05 is statistically significant.

  03

  Research result

  There was no significant difference in patient characteristics. The type and anatomical location of the small intestinal mucosal injury observed during the first CE are shown in Figure 2. The injury location, red, swollen, and swollen lesions were determined based on the observed injury time (relative to the total time for the small sac to pass through the small intestine). Erosion is evenly distributed throughout the small intestine, but ulcers are mostly located in the third segment of the small intestine.

  The median of erosions/ulcers at initial CE in the polyprezinc group was 2 (range 0-6), the median of red and swollen lesions was 3 (range 0-7); the median of the control group was 2 (range 0-7) 0-10) and 2 (range 0-7). As shown in Table 1, the median erosion/ulceration of the follow-up CE in the polyprezinc group was significantly reduced to 0 (range 0-4) (P = 0.039); in the control group, the median erosion/ulceration after the follow-up CE There is no significant difference in the numbers. After follow-up CE, the median swelling lesions in the polyprezinc group was significantly reduced to 1 (range 0-1) (P = 0.003), however, the median swelling lesions in the control group after CE follow-up were not significantly different.

  Number of small intestinal mucosal damage and CE score

  The changes in the number of small intestinal mucosal injuries from initial CE to follow-up CE in the two groups are shown in Figure 4. When the polyprezine group received CE follow-up, the median redness and swelling lesions and erosions/ulcers were significantly reduced (P <0.05). However, in the control group, there was no significant difference in the median redness and swelling lesions and erosions/ulcers after CE follow-up.

  Figure 4. Changes in the number of small intestinal mucosal injuries

  Discuss

  In this study, 20 patients were randomly divided into polyprezinc group and control group. After treatment with polyprezinc, the median of redness and swelling lesions and erosion/ulcers in the small intestine were significantly reduced in patients who took only LDA treatment. In patients, there was no significant difference in the median intestinal redness, swelling, erosions and ulcers in patients without polyprezinc. This study combined with polyprezinc can effectively treat LDA-induced small intestinal mucosal injury, and polyprezinc is a treatment for LDA-induced A safe and effective choice for severe small intestinal mucosal injury.

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