GUT 1998;43:506-511 ( October )

Intestinal permeability and inflammation in patients on NSAIDs

G Sigthorsson,^a J Tibble,^a J Hayllar,^b I Menzies,^b A Macpherson,^a R Moots,^a D Scott,^a M J Gumpel,^b I Bjarnason^a

^a Department of Medicine, King's College School of Medicine and Dentistry, London, UK, ^b Department of Rheumatology, Northwick Park Hospital, Middlesex, UK

Correspondence to: Dr I Bjarnason, Department of Medicine, King's College School of Medicine and Dentistry, Bessemer Road, London SE5 9PJ, UK.

Accepted for publication 31 March 1998

BackgroundThe frequency with which non-steroidal anti-inflammatory drugs (NSAIDs) increase small intestinal permeability and cause inflammation is uncertain.
AimsTo examine small intestinal permeability and inflammation in a large number of patients on long term NSAIDs.
MethodsSixty eight patients receiving six different NSAIDs for over six months underwent combined absorption-permeability tests at three different test dose osmolarities (iso-, hypo-, and hyperosmolar). Two hundred and eighty six patients on 12 different NSAIDs underwent indium-111 white cell faecal excretion studies to assess the prevalence and severity of intestinal inflammation.
ResultsThe iso- and hyperosmolar tests showed significant malabsorption of 3-0-methyl-D-glucose, D-xylose, and L-rhamnose. Intestinal permeability changes were significantly more pronounced and frequent with the hypo- and hyperosmolar as opposed to the iso-osmolar test. Sequential studies showed that four and nine patients (of 13) developed inflammation after three and six months treatment with NSAIDs, respectively. There was no significant difference (p>0.1) in the prevalence (54-72%) or severity of intestinal inflammation in the 286 patients taking the various NSAIDs apart from those on aspirin and nabumetone, these having no evidence of intestinal inflammation. There was no significant correlation between the inflammatory changes and age, sex, dose of NSAID, length of disease, or NSAID ingestion.
ConclusionsIntestinal permeability test dose composition is an important factor when assessing the effects of NSAIDs on intestinal integrity. All the conventional NSAIDs studied were equally associated with small intestinal inflammation apart from aspirin and nabumetone which seem to spare the small bowel.
(GUT 1998;43:506-511)

Keywords: non-steroidal anti-inflammatory drug;  intestinal permeability;  intestinal inflammation;  aspirin;  nabumetone

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© 1998 by Gut
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