日本消化器病学会 アーカイブシステム

セッション情報 The 4th International Forum

Short Oral Presentations（GI mucosal injury 1）
タイトル IF-SOP-4：

Association between small bowel mucosal injuries and history of medication in patients with obscure gastrointestinal bleeding
演者 Kato　Takayuki（Gastroenterology Division, Tokyo Metropolitan Hiroo Hospital, Japan）
共同演者 Fujisawa　Nobutaka（Gastroenterology Division, Tokyo Metropolitan Hiroo Hospital, Japan）, Koyama　Shigeru（Endoscopic Center, Tokyo Metropolitan Hiroo Hospital, Japan）
抄録 Introduction：
　Capsule endoscopy（CE）is established as the first examination for the investigation of obscure gastrointestinal bleeding（OGIB）, and small bowel mucosal injuries are often identified as origin of gastrointestinal bleeding. Recently, some medication drugs, such as NSAIDs and/or low-dose aspirin（LDA）have been known to induce small bowel mucosal injuries. However, history of medication that might be relevant to the diagnostic yield of CE has rarely been reported. Therefore we conducted this study to reveal the association between small bowel mucosal injuries and history of medication in patients with OGIB.
Methods：
　A total of 242 patients with OGIB（overt 149：occult 93）were subjected in this study. According to the results of CE examination, patients with at least one ulcer and/or more than three erosions were recorded as positive CE. To investigate the association between small bowel mucosal injuries and history of medication（anticoagulant drugs, antiplatelet drugs, NSAIDs, H2-RA, PPIs, and rebamipide）in patients with OGIB, univariate and multivariate logistic regression analyses were performed. Clinical characteristics, including comorbidities were also included as variants.
Results：
　In patients with overt OGIB, history of NSAID use was identified as independent predictors of erosive/ulcerated lesions（odds ratio[OR]4.73；95% confidence interval[CI]1.47-15.2, P=0.01）. On the other hand, in patients with occult OGIB, history of LDA（OR 5.68；95% CI 1.22-26.5, P=0.03）and PPI use（OR 3.32；95% CI 1.00-11.0, P=0.05）were identified as independent predictors of erosive/ulcerated lesions.
Conclusions：
　We revealed that history of NSAID and/or LDA use are closely associated with the increased risk of the presence of small bowel erosive/ulcerated lesions. In addition, our results indicated that PPIs may exacerbate small bowel injury, rather than protect the small bowel from injury.
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