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Cyclooxygenase 2 selective inhibitor induced bowel stricture: a case report
  1. O Mir,
  2. R Dhote,
  3. R Scavennec,
  4. S Ropert,
  5. B Christoforov
  1. Department of Internal Medicine, Cochin Hospital, Paris V University, Paris, France
  1. Correspondence to:
    Dr R Dhote
    Service de Médecine Interne 1, Hôpital Cochin, 27 Rue du faubourg, Saint-Jacques 75674, Paris Cedex 14, France; robin.dhotecch.ap-hop-paris.fr

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Several reports have mentioned the role of non-steroidal anti-inflammatory drugs (NSAID) in inducing diaphragm disease and strictures in the small and large bowel.1–3 To our knowledge, there is no such report in patients treated with cyclooxygenase 2 (COX-2) selective inhibitors.

We report the case of a 55 year old man with a past history of axial spondylarthropathy, successfully treated with NSAID from 1975 to 2001; from February 2001, he was treated with celecoxib 400 mg per day for three weeks and then 200 mg/day for two years. He had previous abdominal surgery (appendicectomy) in 1965.

He presented with a 24 hour history of central abdominal pain with persistent vomiting. Clinical and radiological examination confirmed small bowel obstruction. At laparoscopy, a distal ileal obstruction was identified. Coelioscopic laparotomy was then performed, showing evidence of bowel wall stricture; 10 cm of the distal ileum was spared. Macroscopic and microscopic examination of the resected specimen was consistent with a diagnosis of stricture on submucosal ulceration of the small bowel.

This condition is known to be associated with long term use of NSAID. The COX-2 specific inhibitors have been developed in order to improve the gastrointestinal safety of therapy with NSAID. In various clinical trials, COX-2 selective inhibitors have been shown to have similar efficacy to NSAID, with a concomitant association with fewer endoscopic ulcers and serious lower gastrointestinal events.3

This case suggests that COX-2 selective inhibitors can induce bowel wall ulcerations, followed by submucosa fibrosis, which may cause strictures or diaphragm-like disease.

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