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A case of rheumatoid arthritis with protein losing enteropathy induced by multiple diaphragmatic strictures of the small intestine: successful treatment by bougieing under double-balloon enteroscopy
  1. Y Kamata1,
  2. M Iwamoto1,
  3. H Nara1,
  4. T Kamimura1,
  5. N Takayashiki2,
  6. H Yamamoto3,
  7. K Sugano3,
  8. T Yoshio4,
  9. H Okazaki4,
  10. S Minota4
  1. 1Division of Rheumatology and Clinical Immunology, Jichi Medical University, Shimotsuke-shi, Japan
  2. 2Department of Pathology, Jichi Medical University, Shimotsuke-shi, Japan
  3. 3Division of Gastroenterology, Jichi Medical University, Shimotsuke-shi, Japan
  4. 4Division of Rheumatology and Clinical Immunology, Jichi Medical University, Shimotsuke-shi, Japan
  1. Correspondence to:
    Dr Y Kamata
    Division of Rheumatology and Clinical Immunology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigiken, 329-0498, Japan; y.kamata{at}jichi.ac.jp

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Non-steroidal anti-inflammatory drugs (NSAIDs) are the most favoured for the treatment of rheumatoid arthritis (RA) but they sometimes induce inflammation and ulceration of the gastrointestinal tract.1 Approximately 75% of patients receiving long term NSAIDs develop inflammation in the small intestine that in rare cases results in protein losing enteropathy.2,3 Furthermore, NSAIDs can bring about diaphragmatic strictures in the small intestine as a consequence of ulcer healing.

We report here a patient with RA who had multiple diaphragmatic strictures in the small intestine and subsequent protein losing enteropathy, probably due to long term non-steroidal anti-inflammatory drugs use. Her intestinal stricture and protein losing enteropathy, however, were successfully corrected by bougieing under double balloon enteroscopy without resort to surgical resection.

A 57 year old …

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