Nonsteroidal Anti-Inflammatory Drug-Induced Jejunal Ulcer Identified by Capsule Endoscopy.

Abstract

CASE REPORT A 59-year-old woman with a history of systemic lupus erythematosus and arthritis (chronic naproxen use) presented for evaluation of iron deficiency anemia (IDA). Her laboratory test results were consistent with IDA. Upper endoscopy and colonoscopy were nonrevealing. Evaluation with capsule endoscopy revealed a concentric ulceration in the jejunum. Other common causes of IDA including celiac disease, gastrinoma, inflammatory bowel disease, and malignancy were ruled out (Figure 1). This diaphragm-like structure is a rare, but pathognomonic, feature of nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy (Figure 1).1 Patients with NSAID-induced enteropathy present with IDA or symptoms of small bowel obstruction due to diaphragm lesions of the jejunum.2 Iron supplementation resulted in partial improvement of her IDA. This case report highlights the use of new diagnostic modalities, such as video capsule endoscopy, for diagnosis of small bowel injuries caused by NSAIDs. Video capsule endoscopy may assist in identifying these lesions and may be followed by double-balloon enteroscopy if pathologic diagnosis is required.Figure 1.: Concentric ulceration in the jejunum due to NSAID use.DISCLOSURES S.B. Syed and I. Vohra: substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work. S.B. Syed: drafting the work or revising it critically for important intellectual content. I. Vohra, S. Dhillon, and O.S. Khokhar: final approval of the version to be published. S.B. Syed and I. Vohra: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. S.B. Syed is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.