Nonvariceal gastrointestinal (GI) bleeding is common and one of the most frequent
medical events which determine hospitalizations worldwide. Death rates (5-12%) in
patients with GI bleeding are resistant to decrease despite the new advances in diagnosis
and therapy, which is probably linked to a higher proportion of elderly patients with
significant comorbidities who suffer from this complication [
[1]
]. However, the number of hospitalizations due to GI bleeding is decreasing over time
in many countries with a sharp reduction of upper GI bleeding events, which is not
compensated by the observed increase in the number of hospitalizations due to lower
GI bleeding events [
[2]
]. Another aspect that deserved to be outlined here is that the characteristics of
patients who develop GI bleeding have also changed in the last decades. In the past,
most GI bleeding cases were due to peptic ulcers associated to either H. pylori infection
or NSAID use. In contrast, nowadays, the most common patient admitted to our hospitals
with GI bleeding is an elderly man or woman with various comorbidities taking antiplatelet
agents, anticoagulants or both [
[3]
]. There must be several reasons for the observed changes, but it seems obvious that
the worldwide decrease in the prevalence of H. pylori infection in western countries, and the widespread use of proton pump inhibitors
(PPIs) in patients taking NSAIDs are two important factors. Both therapies have shown
to decrease the incidence of peptic ulcers and their complications [
[4]
].To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases.Am J Gastroenterol. 2010; 105 (Jan): 84-89
- Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice.Am J Gastroenterol. 2009; 104 (Jul): 1633-1641
- Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants.Clin Gastroenterol Hepatol. 2015; 13 (May): 906-912
- Non-variceal upper gastrointestinal bleeding.Nat Rev Dis Primers. 2018; 4 (Apr 19): 18020
- Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs.Gastroenterology. 2018; 154 (Feb): 500-514
- Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO).Eur J Intern Med. 2020; S0953-6205 (In press. PMID: 33279389): 30424-30426https://doi.org/10.1016/j.ejim.2020.11.014
- Long-term follow-up of 1,000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding.Am J Gastroenterol. 2012; 107 (Aug): 1197-1204
- Multifaceted Functions of Platelets in Cancer: From Tumorigenesis to Liquid Biopsy Tool and Drug Delivery System.Int J Mol Sci. 2020; 21 (Dec 169585)
- 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2020; 29 (Aug): ehaa575
- Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.Endoscopy. 2015; 47 (Oct): a1-46
- Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group.Ann Intern Med. 2019; 171 (Dec 3): 805-822
- Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial.Gastroenterology. 2019; 157 (Aug): 403-412
- Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen.N Engl J Med. 2001; 344 (Mar 29): 967-973
- Peptic Ulcer Bleeding Risk. The Role of Helicobacter Pylori Infection in NSAID/Low-Dose Aspirin Users.Am J Gastroenterol. 2015; 110 (May): 684-689
- Proton pump inhibitors, adverse events and increased risk of mortality.Expert Opin Drug Saf. 2019; 18 (Nov): 1043-1053
- Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin.Gastroenterology. 2019; 157 (Sep): 682-691
- Investigation of the interaction between proton pump inhibitors and clopidogrel using VerifyNow P2Y12 assay. 99. Medicine (Baltimore), 2020: e23695 (Dec 11)
- Clopidogrel with or without omeprazole in coronary artery disease.N Engl J Med. 2010; 363 (Nov 11): 1909-1917
- Influence of Microbiota on NSAID Enteropathy: A Systematic Review of Current Knowledge and the Role of Probiotics.Adv Ther. 2020; 37 (May): 1933-1945
- Small bowel injury by low-dose enteric-coated aspirin and treatment with misoprostol: a pilot study.Clin Gastroenterol Hepatol. 2008; 6 (Nov, PMID: 18995219): 1279-1282https://doi.org/10.1016/j.cgh.2008.06.021
Article info
Publication history
Published online: January 21, 2021
Accepted:
January 14,
2021
Received:
January 10,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Gastroprotection in patients on antiplatelet and/or anticoagulant therapy: a position paper of National Association of Hospital Cardiologists (ANMCO) and the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO)European Journal of Internal MedicineVol. 85
- PreviewAspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular and cerebrovascular diseases. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed. However, potential increased risk of cardiovascular events has been suggested for PPIs, and, in recent years, it has been discussed whether these drugs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel.
- Full-Text
- Preview
