| セッション情報 | The 4th International ForumI Drug-associated GI Injury：Advances of the pathogenesis and recent clinical topics 2. Recent clinical topics（a）Antiplatelet therapy：Mucosal injuries and drug interaction with PPI |
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| タイトル | IFI-2a-2：Event timing GI damages and eradication of H.pylori eradication in LDA user |
| 演者 | Kawai Takashi（Endoscopy Center, Tokyo Medical University Hospital, Japan） |
| 共同演者 | Moriyasu Fuminori（Gastroenterology and Hepatology, Tokyo Medical University, Japan） |
| 抄録 | Background：Low-dose aspirin（LDA）is widely used for the prevention of cardiovascular events. But LDA has several adverse gastrointestinal（GI）effects, including GI bleeding. MAGIC（Management of Aspirin-induced Gastro-Intestinal Complications）study was conducted in Japan and reported that proton pump inhibitor（PPI）is useful for prevention of peptic ulcer and erosion induced by LDA. But it is unknown when prescription of PPI will start for LDA users? Also it is unknown whether H.pylori（HP）eradication should be conducted for LDA users. Study 1：Transnasal EGD（TN-EGD）was used to observe time-course changes of gastrointestinal mucosa with LDA. 10 HP-negative subjects received daily LDA for 7 days. TN-EGD was performed at 0, 2, 6 and 24 hrs on the first day, and again on the third and seventh days. Ulcers and erosions were recognized in GI at 24 hrs and 72 hrs respectively. Study 2：120 subjects took LDA continuously for at least 3 months, and underwent TN-EGD without ceasing therapy. Endoscopic findings were scored for the antral, body and fundal regions individually. The gastric antral Lanza scores were HP（-）LDA（-）：0.2±0.6, HP（-）LDA（+）：1.8±1.5, HP（+）LDA（-）：0.3±0.7, and HP（+）LDA（+）：0.5±1.0. The gastric body and fundal Lanza scores were 0.1±0.3, 0.5±0.9, 0.1±0.3, and 0.1±0.3, respectively, and 0.0±0.0, 0.1±0.4, 0.0±0.0, and 0.0±0.2, respectively. Using variance analysis of the correlation between HP infection and LDA revealed LDA was an aggressive factor, and HP infection a protective factor in the antrum and fundus. In the gastric body, LDA and HP infection were both aggressive factors. Summary GI events induced by LDA were recognized at early periods after administration of LDA. So we have to prescribe PPI at the early stage of starting of LDA for prevention of GI injuries by LDA. Eradication of HP in LDA users sometimes will aggravate ulcers in the antrum. So eradication and PPI is recommended for prevention of recurrence of peptic ulcers. |
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