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Introduction: Early endoscopic diagnosis and endoscopic therapy are very important in cases of acute gastrointestinal bleeding. Hemospray is an inorganic powder with hemostatic properties recently proposed for the treatment of acute gastrointestinal bleeding., Aim: The aim of the authors was to report the first Hungarian experience obtained with Hemospray in patients with acute gastrointestinal bleeding., Method: During a 14-month period 10 acute upper gastrointestinal bleeder patients were treated endoscopically with Hemospray in 11 settings. In 5 patients previous endoscopic hemostatic methods failed and in the remaining 5 patients Hemospray was administrated as a first-line therapy., Results: Primary hemostasis was achieved in 9 of the 10 patients treated with Hemospray. Two patients died during hospitalization (uncontrolled arterial bleeding in one patient and hepatic encephalopathy in the other one patient). Primary hemostasis and hemodynamic stability were achieved in each of the 4 patients who had thrombopenia., Conclusions: Hemospray as a rescue therapy may ensure primary hemostasis in severe acute gastrointestinal bleeding even in cases with thrombopenia.

Aim: To investigate the effect of mesalazine granules on small intestinal injury induced by naproxen using capsule endoscopy (CE)., Methods: This was a single center, non-randomized, open-label, uncontrolled pilot study, using the PillCam SB CE system with RAPID 5 software. The Lewis Index Score (LIS) for small bowel injury was investigated to evaluate the severity of mucosal injury. Arthropathy patients with at least one month history of daily naproxen use of 1000 mg and proton pump inhibitor co-therapy were screened. Patients with a minimum LIS of 135 were eligible to enter the 4-wk treatment phase of the study. During this treatment period, 3 × 1000 mg/d mesalazine granules were added to ongoing therapies of 1000 mg/d naproxen and 20 mg/d omeprazole. At the end of the 4-wk combined treatment period, a second small bowel CE was performed to re-evaluate the enteropathy according to the LIS results. The primary objective of this study was to assess the mucosal changes after 4 wk of mesalazine treatment., Results: A total of 18 patients (16 females), ranging in age from 46 to 78 years (mean age 60.3 years) were screened, all had been taking 1000 mg/d naproxen for at least one month. Eight patients were excluded from the mesalazine therapeutic phase of the study for the following reasons: the screening CE showed normal small bowel mucosa or only insignificant damages (LIS < 135) in five patients, the screening esophagogastroduodenoscopy revealed gastric ulcer in one patient, capsule technical failure and incomplete CE due to poor small bowel cleanliness in two patients. Ten patients (9 female, mean age 56.2 years) whose initial LIS reached mild and moderate-to-severe enteropathy grades (between 135 and 790 and ≥ 790) entered the 4-wk therapeutic phase and a repeat CE was performed. When comparing the change in LIS from baseline to end of treatment in all patients, a marked decrease was seen (mean LIS: 1236.4 ± 821.9 vs 925.2 ± 543.4, P = 0.271). Moreover, a significant difference between pre- and post-treatment mean total LIS was detected in 7 patients who had moderate-to-severe enteropathy gradings at the inclusion CE (mean LIS: 1615 ± 672 vs 1064 ± 424, P = 0.033)., Conclusion: According to the small bowel CE evaluation mesalazine granules significantly attenuated mucosal injuries in patients with moderate-to-severe enteropathies induced by naproxen.