CT enteroclysis/enterography findings in drug-induced small-bowel damage

Abstract

Objective: To evaluate the CT enteroclysis (CTE)/ enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal antiinflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. Methods: CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). Results: Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. Conclusion: On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. Advances in knowledge: Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE.CT enteroclysis (CTE)/enterography is a technique whereby enteral contrast medium is infused into the small bowel to obtain well-expanded loops and adequate endoluminal opacification for evaluation of lesions.1,2 In recent years, it has been widely recognized that low-dose aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause damage to the mucosa of both the upper gastrointestinal tract and the small bowel.3-8 The usefulness of videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE) in the diagnosis of drug-induced small-bowel damage has been established, but few comprehensive reports have evaluated the CT findings of this condition. 4,5 The CTE findings of drug-induced small-bowel damage were classified into three types, and the duration of drug use and endoscopic findings associated with each type were evaluated. The goal of this retrospective study was to describe the CTE findings in patients with small-bowel mucosal damage induced by NSAIDs, to compare CTE findings with those observed on VCE or DBE and to correlate CTE findings with the duration of drug use. METHODS AND MATERIALSWe reviewed the CTE findings of 11 (5 males and 6 females; mean age, 71 years; range, 56-85 years) patients diagnosed with drug-induced small-bowel damage, among 82 consecutive patients with obsc...

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