Which medication is best for intestinal injuries caused by NSAIDs or aspirin?

TOP LINE:

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

METHODOLOGY:

• More and more people are taking NSAIDs or aspirin to treat and prevent cardiovascular, rheumatic or spinal diseases, which leads to an increased risk of small intestinal injuries among users.
• Researchers conducted a meta-analysis of 18 randomized controlled trials to compare the effectiveness of mucoprotectants for treating and preventing small bowel injury in adults receiving NSAIDs or aspirin.
• In total, the treatment efficacy of rebamipide, misoprostol, probiotics and polaprezink was analyzed in six studies; the prophylactic effect of rebamipide, geranylgeranylacetone, misoprostol, ecabet, equalen, muscovite and rifaximin was analyzed in 12 studies.
• The primary outcome was a change in the number of jejunal or ileal injuries during capsule endoscopy before and after the use of mucoprotective agents.

TAKE AWAY:

• Mucoprotectants reduced the extent of mucosal injury (mean difference –4.74; P = .02), with misoprostol being the only drug with a significant therapeutic effect (mean difference –9.88; P
• They also showed a protective effect against small bowel injury caused by NSAIDs or aspirin (mean difference –1.27; P P

IN PRACTICE:

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

SOURCE:

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

RESTRICTIONS:

Only randomized clinical trials were included in this meta-analysis, which limits the number of patients available. Many studies examining the effectiveness of probiotics for treating intestinal injury were excluded. The effects of proton pump inhibitors, which are often given together with NSAIDs to prevent bleeding, were not considered.

DISCLOSURE:

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