Clin Endosc.  2012 Jun;45(2):138-144. 10.5946/ce.2012.45.2.138.

Non-Steroidal Anti-Inflammatory Drug-Induced Enteropathy

• Lim YJ
• Yang CH

• KMID: 2048851
• DOI: http://doi.org/10.5946/ce.2012.45.2.138

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs in the world. NSAID-induced lower gastrointestinal (GI) complications are increasing while upper GI complications are decreasing. Lower GI events accounted for 40% of all serious GI events in patients on NSAIDs. Capsule endoscopy and device assisted enteroscopy are available for detection of small intestinal lesions. Capsule endoscopy studies have demonstrated that NSAIDs use in healthy volunteers raised the incidence (55% to 75%) of intestinal damage. It appears that selective cyclooxygenase-2 inhibitors (coxibs) improved upper and lower GI safety based on results of clinical trials. Selective coxibs are still capable of triggering GI adverse events and cardiovascular toxicity issues were the main focus of concerns. Unfortunately, definite strategies are not available to prevent or heal NSAID-induced intestinal injuries. Thus, there is still a strong clinical need for effective drugs with improved safety profiles than the existing NSAIDs.

Keyword

Anti-inflammatory agents, non-steroidal; Lower gastrointestinal tract; Cyclooxygenase 2 inhibitors

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Capsule Endoscopy
Cyclooxygenase 2 Inhibitors
Humans
Incidence
Lower Gastrointestinal Tract
Anti-Inflammatory Agents, Non-Steroidal
Cyclooxygenase 2 Inhibitors

Figure

• 

  Fig. 1 Pathophysiology of non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy. NSAIDs suppress cyclooxygenase isoenzymes and directly damage intestinal epithelium. Intercellular junctions weaken and then intraluminal aggressors including polymorphonuclear neutrophils, inflammatory mediators, bile, bacteria, hydrolytic, or proteolytic enzymes attack the intestinal epithelial cells. Secondary damage with ulceration, stricture and blood, or protein loss is augmented by the enterohepatic circulation of NSAID. PG: prostaglandin.

• 

  Fig. 2 A 40-year-old man with recurrent obscure gastrointestinal bleeding (Hb=5.0 mg/dL). He had intermittently taken non-steroidal anti-inflammatory drugs for intractable back pain. Capsule endoscopic finding (A, B) showed ongoing mid-jejunal bleeding without definite mucosal lesion and this bleeding was controlled by clipping through single balloon endoscopy (C, D, E).

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  Fig. 3 Capsule endoscopic findings of non-steroidal anti-inflammatory drug enteropathy. There were denuded areas (A), erosions (B, C, D), and multiple variously-shaped well-demarcated ulcers (E, F).

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