Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
Dig Endosc. 2018 Jan;30(1):79-89. doi: 10.1111/den.12922. Epub 2017 Sep 4.
Although several drugs may induce small-bowel mucosal injuries, it is unclear whether these injuries contribute to overt small-bowel bleeding. This study was designed to evaluate the associations between drug use and small-bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease-relevant population.
We retrospectively studied patients with suspected small-bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small-bowel mucosal injury and small-bowel overt bleeding.
In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small-bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of non-steroidal anti-inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01-3.31) was significantly associated with an increased risk of small-bowel mucosal injury compared with non-use. Patients with small-bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders.
Although the use of NSAIDs was significantly associated with an increased risk of small-bowel mucosal injury, no significant associations were observed between the use of such drugs and small-bowel overt bleeding.
虽然有几种药物可导致小肠黏膜损伤，但这些损伤是否导致显性小肠出血尚不清楚。本研究旨在评估在与疾病相关的人群中，药物使用与小肠黏膜损伤以及这些黏膜损伤与显性出血之间的关联。
我们回顾性研究了 2010 年至 2013 年间接受胶囊内镜检查的疑似小肠疾病患者。在胶囊内镜检查前评估了药物暴露、Charlson 合并症指数、吸烟和饮酒情况。估计了小肠黏膜损伤和小肠显性出血的调整比值比（AOR）和置信区间（CI）。
在研究期间共分析了 850 例患者。中位年龄为 64 岁，544 例（64.0%）为男性。在小肠黏膜损伤患者（n=60）和无黏膜损伤患者（n=705）中，与未使用相比，使用非甾体抗炎药（NSAIDs）（AOR 1.8，95%CI 1.01-3.31）与小肠黏膜损伤风险增加显著相关。在有显性小肠出血的黏膜损伤患者（n=85）和无显性小肠出血的黏膜损伤患者（n=60）之间进行比较，即使在调整混杂因素后，两组 NSAIDs、噻氯匹定、其他抗血小板药物、抗凝剂、对乙酰氨基酚、盐酸曲马多或类固醇的使用率也没有显著差异。
虽然 NSAIDs 的使用与小肠黏膜损伤风险增加显著相关，但这些药物的使用与显性小肠出血之间无显著关联。
