Which Drug Is Best in NSAID or Aspirin-Induced Bowel Injury?

TOPLINE:

Misoprostol is highly effective in treating small bowel injuries caused by nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin, whereas rebamipide offers modest protection against such injuries, according to a meta-analysis.

METHODOLOGY:

• An increasing number of individuals have been using NSAIDs or aspirin to manage and prevent cardiovascular, rheumatic, or spinal diseases, which has led to an elevated risk for small bowel injuries among users.
• Researchers performed a meta-analysis of 18 randomized controlled trials to compare the effectiveness of mucoprotectants for the treatment and prevention of small bowel injuries in adults receiving NSAIDs or aspirin.
• Overall, six studies analyzed the treatment effectiveness of rebamipide, misoprostol, probiotics, and polaprezinc; 12 studies analyzed the prophylactic effect of rebamipide, geranylgeranylacetone, misoprostol, ecabet, equalen, muscovite, and rifaximin.
• The primary outcome was a change in the number of injuries in the jejunum or ileum on capsule endoscopy before and after using mucoprotectants.

TAKEAWAY:

• Mucoprotectants reduced the extent of mucosal injuries (mean difference, −4.74; P = .02), with misoprostol being the only drug with a significant therapeutic effect (mean difference, −9.88; P < .001).
• They also showed a protective effect against NSAID- or aspirin-induced small bowel injuries (mean difference, −1.27; P < .001), with rebamipide being the only drug with a significant prophylactic effect (mean difference, −1.85; P < .001).

IN PRACTICE:

“When prescribing NSAIDs or aspirin, it would be helpful to consider the [small bowel] injuries caused by these drugs and select a mucoprotectant that can prevent or treat this,” the authors wrote.

SOURCE:

The study, led by Younghee Choe, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, the Catholic University of Korea, Seoul, Republic of Korea, was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

Only randomized clinical trials were included in this meta-analysis, limiting the number of available patients. Many studies that investigated the efficacy of probiotics for the treatment of bowel injuries were excluded. The effects of proton pump inhibitors, which are frequently administered along with NSAIDs to prevent bleeding, were not considered.

DISCLOSURES:

The study was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology and by the Korean Research Association for Helicobacter and Microbiome Grant. The authors declared no conflict of interest.