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Efficacy of Lactobacillus casei treatment on small bowel injury in chronic low-dose aspirin users: a pilot randomized controlled study

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Abstract

Background

Few studies have investigated measures to prevent small bowel injuries induced by aspirin. Our aim was to evaluate the effect of probiotic treatment on the small bowel injuries induced by chronic low-dose aspirin use.

Methods

Thirty-five patients who took low-dose enteric-coated aspirin 100 mg daily (for more than 3 months) plus omeprazole 20 mg daily and were diagnosed as having unexplained iron deficiency anemia participated in this prospective randomized controlled trial. We assigned the patients to receive probiotic treatment with Lactobacillus casei for 3 months (L. casei group) or not receive the probiotic (control group). Patients underwent capsule endoscopy (CE) before and after treatment.

Results

Twenty-five patients, including 13 in the L. casei group and 12 in the control group, underwent the full analysis. Significant decreases in the number of mucosal breaks and the CE score were observed at the 3-month evaluation in the L. casei group as compared with the results in the control group (P = 0.039). The change from the baseline in the median number of mucosal breaks in the L. casei group was −2, as compared with 0.5 in the control group. The change from the baseline in the median CE score in the L. casei group was −228 compared with −4 in the control group (P = 0.026).

Conclusions

Co-administration of L. casei is effective for the treatment of aspirin-associated small bowel injury.

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References

  1. Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101:1206–18.

    PubMed  CAS  Google Scholar 

  2. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86.

    Google Scholar 

  3. Patrono C, García Rodríguez LA, Landolfi R, Baigent C. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med. 2005;353:2373–83.

    Article  PubMed  CAS  Google Scholar 

  4. Weil J, Colin-Jones D, Langman M, Lawson D, Logan R, Murphy M, et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ. 1995;310:827–30.

    PubMed  CAS  Google Scholar 

  5. Patrono C. Aspirin as an antiplatelet drug. N Engl J Med. 1994;330:1287–94.

    Article  PubMed  CAS  Google Scholar 

  6. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000;405:417.

    Article  PubMed  CAS  Google Scholar 

  7. Yamamoto H, Sekine Y, Sato Y, Higashiwaza T, Miyata T, Iino S, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53:216–20.

    Article  PubMed  CAS  Google Scholar 

  8. Endo H, Hosono K, Inamori M, Kato S, Nozaki Y, Yoneda K, et al. Incidence of small bowel injury induced by low-dose aspirin: a crossover study using capsule endoscopy in healthy volunteers. Digestion. 2009;79:44–51.

    Article  PubMed  CAS  Google Scholar 

  9. Endo H, Hosono K, Inamori M, Nozaki Y, Yoneda K, Fujita K, et al. Characteristics of small bowel injury in symptomatic chronic low-dose aspirin users: the experience of two medical centers in capsule endoscopy. J Gastroenterol. 2009;44:544–9.

    Article  PubMed  CAS  Google Scholar 

  10. Matsumoto T, Kudo T, Esaki M, Yano T, Yamamoto H, Sakamoto C, et al. Prevalence of non-steroidal anti-inflammatory drug-induced enteropathy determined by double-balloon endoscopy: a Japanese multicenter study. Scand J Gastroenterol. 2008;43:490–6.

    Article  PubMed  CAS  Google Scholar 

  11. Graham DY, Smith JL. Aspirin and the stomach. Ann Intern Med. 1986;104:390–8.

    PubMed  CAS  Google Scholar 

  12. Watanabe T, Higuchi K, Kobata A, Nichio H, Tanigawa T, Shiba M, et al. Non-steroidal anti-inflammatory drug-induced small intestinal damage is Toll-like receptor 4 dependent. Gut. 2008;57:181–7.

    Article  PubMed  CAS  Google Scholar 

  13. Fuller R. Probiotics in human medicine. Gut. 1991;32:439–42.

    Article  PubMed  CAS  Google Scholar 

  14. Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon AT. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet. 1999;354:635–9.

    Article  PubMed  CAS  Google Scholar 

  15. Sood A, Midha V, Makharia GK, Ahuja V, Singal D, Goswami P, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol. 2009;7:1202–9.

    Article  PubMed  Google Scholar 

  16. Asahara T, Nomoto K, Watanuki M, Yokokura T. Antimicrobial activity of intraurethrally administered probiotic Lactobacillus casei in a murine model of Escherichia coli urinary tract infection. Antimicrob Agents Chemother. 2001;45:1751–60.

    Article  PubMed  CAS  Google Scholar 

  17. Sgouras D, Maragkoudakis P, Petraki K, Martinez-Gonzalez B, Eriotou E, Michopoulos S, et al. In vitro and in vivo inhibition of Helicobacter pylori by Lactobacillus casei strain Shirota. Appl Environ Microbiol. 2004;70:518–26.

    Article  PubMed  CAS  Google Scholar 

  18. Chung YW, Choi JH, Oh TY, Eun CS, Han DS. Lactobacillus casei prevents the development of dextran sulphate sodium-induced colitis in Toll-like receptor 4 mutant mice. Clin Exp Immunol. 2008;151:182–9.

    Article  PubMed  CAS  Google Scholar 

  19. Watanabe T, Nishio H, Tanigawa T, Yamagami H, Okazaki H, Watanabe K, et al. Probiotic Lactobacillus casei strain Shirota prevents indomethacin-induced small intestinal injury: involvement of lactic acid. Am J Physiol Gastrointest Liver Physiol. 2009;297:G506–13.

    Article  PubMed  CAS  Google Scholar 

  20. Montalto M, Gallo A, Curigliano V, D’Onofrio F, Santoro L, Covino M, et al. Clinical trial: the effects of a probiotic mixture on non-steroidal anti-inflammatory drug enteropathy—a randomized, double-blind, cross-over, placebo-controlled study. Aliment Pharmacol Ther. 2010;32:209–14.

    Article  PubMed  CAS  Google Scholar 

  21. Fujimori S, Seo T, Gudis K, Ehara A, Kobayashi T, Mitsui K, et al. Prevention of nonsteroidal anti-inflammatory drug-induced small-intestinal injury by prostaglandin: a pilot randomized controlled trial evaluated by capsule endoscopy. Gastrointest Endosc. 2009;69:1339–46.

    Article  PubMed  Google Scholar 

  22. Gralnek IM, Defranchis R, Seidman E, Leighton JA, Legnani P, Lewis BS. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther. 2008;27:146–54.

    Article  PubMed  CAS  Google Scholar 

  23. Endo H, Hosono K, Higurashi T, Sakai E, Iida H, Sakamoto Y, et al. Quantitative of low-dose aspirin-associated small bowel injury using a capsule endoscopy scoring index. Dig Endosc. 2011;23:56–61.

    Article  PubMed  Google Scholar 

  24. Davies NM, Jamali F. Pharmacological protection of NSAID-induced intestinal permeability in the rat: effect of tempo and metronidazole as potential free radical scavengers. Hum Exp Toxicol. 1997;16:345–9.

    Article  PubMed  CAS  Google Scholar 

  25. Banerjee AK, Peters TJ. Experimental non-steroidal anti-inflammatory drug-induced enteropathy in the rat: similarities to inflammatory bowel disease and effect of thromboxane synthetase inhibitors. Gut. 1990;31:1358–64.

    Article  PubMed  CAS  Google Scholar 

  26. Koga H, Aoyagi K, Matsumoto T, Iida M, Fujishima M. Experimental enteropathy in athymic and euthymic rats: synergistic role of lipopolysaccharide and indomethacin. Am J Physiol. 1999;276:G576–82.

    PubMed  CAS  Google Scholar 

  27. Bjarnason I, Hayllar J, Smethurst P, Price A, Gumpel MJ. Metronidazole reduces intestinal inflammation and blood loss in non-steroidal anti-inflammatory drug induced enteropathy. Gut. 1992;33:1204–8.

    Article  PubMed  CAS  Google Scholar 

  28. Kent TH, Cardelli RM, Stamler FW. Small intestinal ulcers and intestinal flora in rats given indomethacin. Am J Pathol. 1969;54:237–49.

    PubMed  CAS  Google Scholar 

  29. Scarpignato C. NSAID-induced intestinal damage: are luminal bacteria the therapeutic target? Gut. 2008;57:145–8.

    Article  PubMed  CAS  Google Scholar 

  30. Hütt P, Shchepetova J, Lõivukene K, Kullisaar T, Mikelsaar M. Antagonistic activity of probiotic lactobacilli and bifidobacteria against entero- and uropathogens. J Appl Microbiol. 2006;100:1324–32.

    Article  PubMed  Google Scholar 

  31. Matsumoto S, Hara T, Hori T, Mitsuyama K, Nagaoka M, Tomiyasu N, et al. Probiotic Lactobacillus-induced improvement in murine chronic inflammatory bowel disease is associated with the down-regulation of pro-inflammatory cytokines in lamina propria mononuclear cells. Clin Exp Immunol. 2005;140:417–26.

    Article  PubMed  CAS  Google Scholar 

  32. Ingrassia I, Leplingard A, Darfeuille-Michaud A. Lactobacillus casei DN-114001 inhibits the ability of adherent-invasive Escherichia coli isolated from Crohn’s disease patients to adhere to and to invade intestinal epithelial cells. Appl Environ Microbiol. 2005;71:2880–7.

    Article  PubMed  CAS  Google Scholar 

  33. Bertrand V, Guimbaud R, Tulliez M, Mauprivez C, Sogni P, Couturier D, et al. Increased in tumor necrosis factor-alpha production linked to the toxicity of indomethacin for the rat small intestine. Br J Pharmacol. 1998;124:1385–94.

    Article  PubMed  CAS  Google Scholar 

  34. Saud B, Nandi J, Ong G, Finocchiaro S, Levine RA. Inhibition of TNF-alpha improves indomethacin-induced enteropathy in rats by modulating iNOS expression. Dig Dis Sci. 2005;50:1677–83.

    Article  PubMed  CAS  Google Scholar 

  35. Borruel N, Carol M, Casellas F, Antolín M, de Lara F, Espín E, et al. Increased mucosal tumor necrosis factor alpha production in Crohn’s disease can be downregulated ex vivo by probiotic bacteria. Gut. 2002;51:659–64.

    Article  PubMed  CAS  Google Scholar 

  36. Van Gossum A, Dewit O, Louis E, de Hertogh G, Baert F, Fontaine F, et al. Multicenter randomized-controlled clinical trial of probiotics (Lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn’s disease after ileo-caecal resection. Inflamm Bowel Dis. 2007;12:135–42.

    Article  Google Scholar 

  37. Kuisma J, Mentula S, Jarvinen H, Kahri A, Saxelin M, Farkkila M. Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Aliment Pharmacol Ther. 2003;17:509–15.

    Article  PubMed  CAS  Google Scholar 

  38. Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Zlotnick S, Fort JG, et al. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol. 2005;3:133–41.

    Article  PubMed  Google Scholar 

  39. Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Aisenberg J, Bhadra P, et al. Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther. 2007;15:1211–22.

    Article  Google Scholar 

  40. Bjarnason I, Smethurst P, Fenn CG, Lee CE, Menzies IS, Levi AJ. Misoprostol reduces indomethacin-induced changes in human small intestinal permeability. Dig Dis Sci. 1989;34:407–11.

    Article  PubMed  CAS  Google Scholar 

  41. Watanabe T, Sugimori S, Kameda N, Machida H, Okazaki H, Tanigawa T, et al. Small bowel injury by low-dose enteric-coated aspirin and treatment with misoprostol: a pilot study. Clin Gastroenterol Hepatol. 2008;6:1279–82.

    Article  PubMed  Google Scholar 

  42. Fujimori S, Gudis K, Takahashi Y, Seo T, Yamada Y, Ehara A, et al. Distribution of small intestinal mucosal injuries as a result of NSAID administration. Eur J Clin Invest. 2010;40:504–10.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by Health and Labour Sciences Research Ministry of Health, Labour and Welfare of Japan to A.N.

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The authors of the article have nothing to disclose.

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Correspondence to Hiroki Endo.

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Endo, H., Higurashi, T., Hosono, K. et al. Efficacy of Lactobacillus casei treatment on small bowel injury in chronic low-dose aspirin users: a pilot randomized controlled study. J Gastroenterol 46, 894–905 (2011). https://doi.org/10.1007/s00535-011-0410-1

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