Intestinal Research

Original Articles

Gastrointestinal bleeding risk of non-vitamin K antagonist oral anticoagulants versus warfarin in general and after polypectomy: a population-based study with propensity score matching analysis: Jong Yop Pae, Eun Soo Kim, Sung Kook Kim, Min Kyu Jung, Jun Heo, Jang Hoon Lee, Min Ae Park; Intest Res 2022;20(4):482-494. Published online April 15, 2022; DOI: https://doi.org/10.5217/ir.2021.00161

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Background/Aims
Gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin is largely unknown. We aimed to determine the risk of overall and post-polypectomy GIB for NOACs and warfarin.
Methods
Using the Korean National Health Insurance database, we created a cohort of patients who were newly prescribed NOACs or warfarin between July 2015 and December 2017 using propensity score matching (PSM). Kaplan-Meier analysis with log-rank test was performed to compare the risk of overall and post-polypectomy GIB between NOACs (apixaban, dabigatran, and rivaroxaban) and warfarin. Post-polypectomy GIB was defined as bleeding within 1 month after gastrointestinal endoscopic polypectomy.
Results
Out of 234,206 patients taking anticoagulants (187,687 NOACs and 46,519 warfarin), we selected 39,764 pairs of NOACs and warfarin users after PSM. NOACs patients showed significantly lower risk of overall GIB than warfarin patients (log-rank P<0.001, hazard ratio, 0.86; 95% confidence interval, 0.78–0.94; P=0.001). Among NOACs, apixaban showed the lowest risk of GIB. In the subgroup of 7,525 patients who underwent gastrointestinal polypectomy (lower gastrointestinal polypectomy 93.1%), 1,546 pairs were chosen for each group after PSM. The NOACs group showed a high risk of post-polypectomy GIB compared with the warfarin group (log-rank P=0.001, hazard ratio, 1.97; 95% confidence interval, 1.16–3.33; P=0.012).
Conclusions
This nationwide, population-based study demonstrates that risk of overall GIB is lower for NOACs than for warfarin, while risk of post-polypectomy GIB is higher for NOACs than for warfarin.

Citations

Citations to this article as recorded by

Safety of cold snare resection techniques for removal of polyps in the small colon in patients taking clopidogrel and aspirin: a Korean Association for the Study of Intestinal Diseases prospective multicenter study
Tae-Geun Gweon, Hyun Gun Kim, Yunho Jung, Seong Ran Jeon, Soo-Young Na, Yoo Jin Lee, Tae Ho Kim
Gastrointestinal Endoscopy.2025; 101(4): 866. CrossRef
Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
Hisham Wehbe, Aditya Gutta, Mark A. Gromski
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 363. CrossRef
Anticoagulant-related bleeding as a sign of underlying tumoural lesions in patients with atrial fibrillation: a nationwide cohort study
Kristiaan Proesmans, Maxim Grymonprez, Sylvie Rottey, Lies Lahousse, Magnus Bäck
European Heart Journal Open.2024;[Epub] CrossRef
Re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy
Won Shik Kim, Seung Han Kim, Moon Kyung Joo, Jong-Jae Park, Beom Jae Lee, Hoon Jai Chun
Annals of Medicine.2023;[Epub] CrossRef
Nonvitamin K oral anticoagulants with proton pump inhibitor cotherapy ameliorated the risk of upper gastrointestinal bleeding
Parata Chaiyana, Karjpong Techathuvanan, Supatsri Sethasine
Scientific Reports.2023;[Epub] CrossRef

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A Double-Blind, Randomized, Active Drug Comparative, Parallel-Group, Multi-Center Clinical Study to Evaluate the Safety and Efficacy of Probiotics (Bacillus licheniformis, Zhengchangsheng® capsule) in Patients with Diarrhea: Jun Heo, Sung Kook Kim, Kyung Sik Park, Hye Kyung Jung, Joong Goo Kwon, Byung Ik Jang; Intest Res 2014;12(3):236-244. Published online July 25, 2014; DOI: https://doi.org/10.5217/ir.2014.12.3.236

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

Bacillus Licheniformis, a probiotic used in the treatment of diarrhea, has been shown to suppress the growth of pathologic bacteria. This study was performed to assess the therapeutic efficacy and safety of Zhengchangsheng® (Bacillus Licheniformis) in comparison with another probiotic, Bioflor® (Saccharomyces Boulardii) for the treatment of diarrhea.

Methods

Patients with diarrhea (n=158) were randomized to receive Zhengchangsheng® or Bioflor® for 5 days. The existence or non-existence of formed feces, changes in daily stool frequency, improvement of subjective symptoms, and changes in the severity of diarrhea were compared.

Results

Of the 158 full analysis set (FAS) patient population, 151 patients comprised the per protocol (PP) analysis. The rates of recovered to formed feces in the Bacillus and Saccharomyces groups were 91.0% vs. 95.0% in the FAS (P=0.326) and 90.5% vs. 96.1% in the PP analysis (P=0.169), respectively. The mean duration of diarrhea changing to formed feces was 3.15±1.10 days in the Bacillus group and 3.22±1.01 in the Saccharomyces group (P=0.695, FAS). The frequency of defecation, subjective symptoms, and degree of severe diarrhea were improved in both groups, however, there were no statistically significant differences between the 2 groups. Analysis of the 95% confidence intervals for the differences in the rate of recovery to formed feces between the 2 groups met the criteria for non-inferiority of Bacillus compared to Saccharomyces. No significant adverse events were observed during the study period.

Conclusions

Zhengchangsheng® is not inferior to Bioflor® in therapeutic efficacy and is a safe and useful therapeutic agent for the treatment of diarrhea.

Citations

Citations to this article as recorded by

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Lipei Wu, Fujun Shen, Weiwei Wang, Chunrun Qi, Chunbin Wang, Anquan Shang, Shihai Xuan
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BioMed Research International.2020;[Epub] CrossRef
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Y. Li, M. Liu, J. Zhou, B. Hou, X. Su, Z. Liu, J. Yuan, M. Li
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VANDA SARGAUTIENE, ILVA NAKURTE, VIZMA NIKOLAJEVA
Polish Journal of Microbiology.2018; 67(3): 307. CrossRef
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M. Hatanaka, K. Yamamoto, N. Suzuki, S. Iio, T. Takara, H. Morita, T. Takimoto, T. Nakamura
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Xiao-Sheng Liang, Chun Liu, Zhu Long, Xiao-Hua Guo
AMB Express.2018;[Epub] CrossRef
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Jai Hyun Rhyou
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Case Report

A Pityrosporum Fungal Infection Following Infliximab Therapy in a Crohn's Disease Patient: Keun Young Shin, Jun Heo, Min Kyu Jung, Seong Woo Jeon, Sung Kook Kim; Intest Res 2010;8(2):177-180. Published online December 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.2.177

Abstract PDF: Crohn's disease (CD) is a chronic immune-mediated inflammatory disorder. Treatment strategies for CD are targeted toward various components of the proinflammatory mediators and subsequent immune response. Recently, the anti-tumor necrosis factor (TNF) monoclonal antibody, infliximab has been used in patients with CD. However, uncommon and unusual infections have been reported during anti-TNF-Ձ therapy and immunomodulator. Here, we report a case of pityriasis versicolor occurring in a patient with CD receiving infliximab treatment. The patient was successfully treated with topical ketoconazole. (Intest Res 2010;8:177-180)

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