Objective: to evaluate the type, frequency, and severity of macroscopic small bowel mucosal injury after chronic NSAID intake as assessed by capsule endoscopy (CE), as well as to correlate the severity of gastroduodenal and intestinal damage in these patients.Material and methods: a prospective, endoscopist-blind, controlled trial. Sixteen patients (14F/2M; age: 57.06 ± 10.16 yrs) with osteoarthritis (OA) on chronic therapy with NSAIDs underwent CE and upper gastrointestinal endoscopy (UGE). Seventeen patients with OA (9F/2M; age: 57.47 ± 9.82 yrs) who did not take NSAIDs were included as a control group. A scale ranging from 0 to 2 (0 = no lesions, 1-minor = red spots or petechiae, denuded areas and/or 1-5 mucosal breaks; 2-major = > 5 mucosal breaks and/or strictures, or hemorrhage) was designed to assess the severity of small bowel mucosal injuries.Results: CE found intestinal lesions in 75% (12/16) of patients in the study group and in 11.76% (2/17) of controls (p < 0.01). Seven out of 16 NSAID consumers (43.75%) and none in the control group (0%) had a major small bowel mucosal injury (p < 0.01). The percentages of patients with grade 1 and 2 gastroduodenopathy in the study group, as assessed by UGE, were 37.14 and 23.81%, respectively. There was no significant difference in the rate of major enteropathy between patients with none or minor gastroduodenal injury, and those with major gastroduodenopathy (43.75 vs. 40%; p = N.S.).Conclusions: chronic NSAID intake is associated with a high rate of small bowel mucosal injuries. Our data have failed to demonstrate a relationship between the severity of gastroduodenal and intestinal injury.Key words: NSAID. Small bowel mucosal injury. Capsule endoscopy. Enteropathy. Prospective. Controlled.
INTRODUCTIONNonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a significant risk of gastrointestinal events with clinical and economic consequences (1-6). Gastric and duodenal ulcerations are the most widely studied manifestations of injury to the gastrointestinal tract caused by NSAIDs, but these medications also can affect the jejunum and ileum, and can cause other types of abnormalities (inflammation, stricture, perforation, mucosal diaphragms and villous atrophy) (7,8).Most of the previously available knowledge about the small bowel comes from autopsy examinations (9), case reports (10) or case series (11). Some techniques have been devised to study the small bowel injury ( 111 In-labeled leukocytes, 51 Cr-EDTA, fecal calprotectin levels), but they are indirect and are not generally available to the clinician (8). Push enteroscopy provides good visualization of the small bowel mucosa, and it has been used to study NSAID enteropathy (12), but does not examine the entire gut, is timeconsuming, cumbersome for the patient, and usually requires sedation (13). Therefore, the true prevalence, location and extent of NSAID enteropathy are still unclear.Capsule endoscopy (CE) is a new diagnostic method that has recently made non-invasive digital imaging of the enti...
