Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10477
Peer-review started: August 31, 2016
First decision: September 20, 2016
Revised: September 28, 2016
Accepted: November 12, 2016
Article in press: November 13, 2016
Published online: December 28, 2016
Core tip: Proton pump inhibitors (PPIs) reduce the risk of upper, but not lower gastrointestinal bleeding (LGB) in patients receiving nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin. PPIs could exacerbate small bowel damage related to NSAIDs and low-dose aspirin, which contributes to an increased risk of LGB possibly related to pathological modifications of small bowel microbiota. LGB is a life-threatening condition, especially in older patients with comorbidities treated with NSAIDs, aspirin, or anticoagulants. No accepted treatments exist for decreasing the risk of LGB in these patients. Future research is needed on reducing inappropriate PPI use and evaluating possible pharmacologic interventions to decrease the risk of gastrointestinal bleeding.