Non-steroidal Anti-inflammatory Drug Induced Injury to the Small Intestine

Ilja Tachecí,Jan Bureš,Stanislav Rejchrt,Marcela Kopáčová

doi:10.14712/18059694.2016.56

Abstract

Non-steroidal anti-inflammatory drug (NSAIDs) induced enteropathy represents an important complication of one of the most commonly used drugs worldwide. Due to previous diagnostics difficulties the real prevalence of this disease was underestimated for a long time. The pathogenesis of NSAID-enteropathy is more multifactorial and complex than formerly assumed but has still not been fully uncovered. A combination of the local and systemic effect plays an important role in pathogenesis. Thanks to novel enteroscopy methods (wireless capsule endoscopy, double balloon enteroscopy), small bowel lesions are described in a substantial section of NSAID users although most are clinically asymptomatic. The other non-invasive tests (small bowel permeability, faecal calprotectin, scintigraphy using faecal excretion of 111-indium-labelled leukocytes etc.) proposed for diagnostics are not generally used in clinical practice, mainly because of their non-specificity. Despite intensive research into possible treatment, the main measure for patients with NSAID-enteropathy is still withdrawal of NSAIDs. Double balloon enteroscopy plays an important role in the treatment of complications (bleeding, strictures).

Highlights

HistoryNon-steroidal anti-inflammatory drugs (NSAIDs) represent the group of most commonly used drugs worldwide
Capsule endoscopy studies confirmed small bowel lesions in 26–88 % patients treated with non-selective NSAIDs, 6–50 % patients treated with COX-2 selective NSAIDs, and 80 % of patients treated with low-dose aspirin [23, 29, 30, 32, 36, 59, 81]
One of the most surprising items of information from capsule endoscopy studies is the presence of small bowel lesions in about 7–41 % of healthy subjects or the controls, mostly small erosions and red spots. This fact somewhat complicated interpretation of results of the studies, because of the likely clinical insignificance of part of these findings identified by capsule endoscopy in NSAIDs users

Summary

Introduction

Non-steroidal anti-inflammatory drugs (NSAIDs) represent the group of most commonly used drugs worldwide. In most patients, increased intestinal permeability and mucosal inflammation can be found in non-invasive laboratory tests Those tests allowed the first objective confirmation of NSAID-induced enteropathy in the past. Capsule endoscopy studies confirmed small bowel lesions in 26–88 % patients treated with non-selective NSAIDs, 6–50 % patients treated with COX-2 selective NSAIDs, and 80 % of patients treated with low-dose aspirin [23, 29, 30, 32, 36, 59, 81]. This fact somewhat complicated interpretation of results of the studies, because of the likely clinical insignificance of part of these findings identified by capsule endoscopy in NSAIDs users Another possible limitation is the frequently insufficient differential diagnostics before or after capsule endoscopy to exclude other possible parallel causes of the described lesions (Crohn’s disease, vasculitis, ischaemic enteritis etc.). Endoscopic and/or surgical treatment can be indicated in case of complications (strictures, bleeding, perforation) [47]

Conclusions

26. Freeman HJ

35. Hawkey CJ

Findings

90. Whittle BJ