Clinical-alimentary tractA Quantitative Analysis of NSAID-Induced Small Bowel Pathology by Capsule Enteroscopy
Section snippets
Materials and Methods
Forty healthy volunteers (23 men and 17 women; mean age, 35 years; range, 21–61 years), mostly hospital staff, from London, England, and Reykjavik, Iceland, were recruited for this study. The main exclusion criteria included recent (in the past month) NSAID or aspirin intake, history of regular NSAID or aspirin use, NSAID hypersensitivity, pregnancy, alcohol or substance misuse, and any serious central nervous system, psychiatric, cardiovascular, respiratory, musculoskeletal, and intestinal
Capsule Enteroscopy
The baseline capsule study was incomplete in 2 volunteers. All 40 repeat studies were complete. Baseline capsule images showed that 3 volunteers had incidental lymphangiectasiae and a further 3 each had a single angiodysplastic lesion. No other pathology was seen.
After 2 weeks of treatment with diclofenac and omeprazole, 27 of the 40 volunteers (68%) had demonstrable pathology not previously seen at baseline as shown in Table 1. Fifteen volunteers (38%) had more than one category of lesion
Discussion
This study shows a high prevalence of NSAID-induced enteropathy, as shown by elevated fecal calprotectin concentrations, after a fortnight’s ingestion of diclofenac and omeprazole in volunteers. The capsule enteroscopy shows that the macroscopic morphologic correlates of this damage are abnormalities ranging from subtle reddening of mucosal folds to that of discrete erosions and ulcers and occasional bleeding.
It is not in doubt that conventional NSAIDs cause small bowel damage in humans.5 This
References (26)
- et al.
Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine
Gastroenterology
(1993) - et al.
Intestinal permeability and inflammation in rheumatoid arthritis; effects of non-steroidal anti-inflammatory drugs
Lancet
(1984) - et al.
Blood and protein loss via small intestinal inflammation induced by nonsteroidal anti-inflammatory drugs
Lancet
(1987) - et al.
Nonsteroidal antiinflammatory drug induced intestinal inflammation in humans
Gastroenterology
(1987) - et al.
Clinico-pathological features of nonsteroidal antiinflammatory drug induced small intestinal strictures
Gastroenterology
(1988) - et al.
Serious lower gastrointestinal clinical events with nonselective NSAID or coxib use
Gastroenterology
(2003) - et al.
Enteroscopic diagnosis of small bowel ulceration in patients receiving non-steroidal antiinflammatory drugs
Lancet
(1991) - et al.
A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease
Gastroenterology
(2002) - et al.
Comparison of wireless capsule endoscopy, ileoscopy and small bowel follow through for the evaluation of non-stricturing IBD
Am J Gastroenterol
(2002) Comparison of capsule endoscopy to other modalities in the small bowel
Gastrointest Endosc Clin North Am
(2004)
Towards a GI safer antiinflammatory therapy
Gastroenterol Int
Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomised controlled trial. Celecoxib Long-term Arthritis Study
JAMA
Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs
Ann Intern Med
Cited by (453)
Safety of surfactant excipients in oral drug formulations
2023, Advanced Drug Delivery ReviewsLoxoprofen enhances intestinal barrier function via generation of its active metabolite by carbonyl reductase 1 in differentiated Caco-2 cells
2021, Chemico-Biological InteractionsGuidelines for best practices in monitoring established coeliac disease in adult patients
2024, Nature Reviews Gastroenterology and HepatologyDrug-Associated Gastropathy: Diagnostic Criteria
2023, Diagnostics
Supported by an unconditional grant from Pfizer. B.T. and I.B. have received honoraria for lectures and research grants from a number of companies that produce anti-inflammatory drugs.