Abstract
Gastrointestinal mucosal damage is a widely recognized complication of therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). 1 Bjarnason I Hayllar J MacPherson AJ Russell AS. Side effects of nonsteroidal anti-inflammatory drug on the small and large intestine in humans. Gastroenterology. 1993; 104: 1832-1847 Abstract PubMed Scopus (881) Google Scholar A less common but increasingly recognized complication is thin mucosal “diaphragm-like” strictures that were initially reported in the small intestine. 2 Neoptolemos JP Locke TJ. Recurrent small bowel obstruction associated with phenylbutazone. Br J Surg. 1983; 70: 244-245 Crossref PubMed Scopus (34) Google Scholar , 3 Bjarnason I Price AB Zanelli G et al. Clinicopathological features of nonsteroidal antiinflammatory drug-induced small intestinal strictures. Gastroenterology. 1988; 94: 1070-1074 PubMed Google Scholar , 4 Lang J Price AB Levi AJ Burke M Gumpel JM Bjarnason I. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol. 1988; 41: 516-526 Crossref PubMed Scopus (284) Google Scholar , 5 Hershfield NB. Endoscopic demonstration of non-steroidal anti-inflammatory drug-induced small intestinal strictures. Gastrointest Endosc. 1992; 38: 388-390 Abstract Full Text PDF PubMed Scopus (24) Google Scholar More recently, similar strictures in the colon have been described in association with the use of slow-release diclofenac, 6 Huber T Ruchti C Halter F. Nonsteroidal antiinflammatory drug-induced colonic strictures: a case report. Gastroenterology. 1991; 100: 1119-1122 PubMed Google Scholar , 7 Fellows IW Clarke JMF Roberts PF. Non-steroidal anti-inflammatory drug-induced jejunal and colonic diaphragm disease: a report of two cases. Gut. 1992; 33: 1424-1426 Crossref PubMed Scopus (87) Google Scholar , 8 Halter F Weber B Huber T Eigenmann F Frey MP Ruchti C. Diaphragm disease of the ascending colon; association with sustained-release diclofenac. J Clin Gastroenterol. 1993; 16: 74-80 Crossref PubMed Scopus (92) Google Scholar , 9 Whitcomb DC Martin SP Trellis DR Evans BA Becich MJ. Diaphragmlike stricture and ulcer of the colon during diclofenac treatment. Arch Intern Med. 1992; 152: 2341-2343 Crossref PubMed Scopus (57) Google Scholar aspirin, 10 Monahan DW Starnes EC Parker AL. Colonic strictures in a patient on long-term non-steroidal anti-inflammatory drugs. Gastrointest Endosc. 1992; 38: 385-388 Abstract Full Text PDF PubMed Scopus (58) Google Scholar or a combination of various NSAIDs, 11 Haque S Haswell JE Dreznick JT West AB. A cecal diaphragm associated with the use of nonsteroidal anti-inflammatory drugs. J Clin Gastroenterol. 1992; 15: 332-335 Crossref PubMed Scopus (37) Google Scholar , 12 Sheers R Williams WR. NSAIDs and gut damage. Lancet. 1989; 2 ([Letter]): 1154 Abstract PubMed Scopus (45) Google Scholar including fenoprofen, indomethacin, piroxicam, sulindac, and meclofenamate. Although the possibility that these strictures are congenital cannot be entirely excluded, they are generally believed to be caused by inflammation and directly related to the local or systemic effects of NSAIDs on the intestinal mucosa. In most case reports of colonic diaphragm-like strictures, the topical effects of NSAIDs were believed to be crucial to both diaphragm formation and any associated ulceration.
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