Diaphragm-like Strictures of the Ileum Associated With NSAID Use: A Rare Complication

Abrahamian, Gregory A; Polhamus, Clinton D.; Muskat, Peter; Karulf, Richard E.

doi:10.1097/00007611-199804000-00018

Cited by 22 publications

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“…The majority of the specimens were obtained because of retention of the video capsule, suggesting the difficult preoperative diagnosis of this condition. The gross and clinical features were typical and similar to those reported in the literature, [3][4][5][6][7][8][9][10][11][12][13][14][15]26,29 with the exception of the diagnosis being reached by video capsule endoscopy in 6 of our cases.…”

Section: Discussionsupporting

confidence: 83%

“…The importance of NSAID-related enteropathy has been emphasized recently, 2 but the histologic features of DD of the small intestine have been reported in only a limited number of cases. [3][4][5][6][7][8][9][10][11][12][13][14] The initial thorough description of DD by Lang et al 15 was followed by several others [16][17][18][19] that have revealed few additional findings. These additional findings have included villous atrophy, 16 association or overlap with socalled neuromuscular and vascular hamartoma (NMVH), 17 rare association with pseudoneoplastic lesions such as inflammatory fibroid polyp (IFP), 18 and, recently, an entity called NSAID-associated submucosal fibrous nodules of the small intestine.…”

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confidence: 99%

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Histopathology of Diaphragm Disease of the Small Intestine

Petris

López

2008

Am J Clin Pathol

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Diaphragm disease (DD) is an uncommon gastrointestinal abnormality typical of nonsteroidal anti-inflammatory drug (NSAID)-induced injury. DD of the small intestine is well defined in its gross appearance (multiple circumferential stenosing lesions); however, its histologic features have been studied in few cases. To better define and update the histologic features of DD, we describe 10 cases in which patients underwent resection of portions of small intestine for DD. Selected gross features and 12 microscopic features were assessed. The typical gross appearance of DD was associated with focal chronic injury of the mucosa with mild to moderate inflammatory infiltrate. A wide array of additional abnormalities was found: eosinophilic enteritis (3 cases), inflammatory fibroid polyp (1 case), enteritis cystica profunda (1 case), villous atrophy (1 case), and neuromuscular and vascular hamartoma-like changes (9 cases). DD and, therefore, NSAID-related injury, should be considered in the differential diagnosis of several conditions affecting the small intestine.

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Section: Discussionsupporting

confidence: 83%

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confidence: 99%

Histopathology of Diaphragm Disease of the Small Intestine

Petris

López

2008

Am J Clin Pathol

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“…NSAID-induced small bowel strictures were first described by Lang et al (1988). Since then, there have been a number of publications on the occurrence of mucosal ulceration, perforation and intestinal strictures in the small and large bowel after longterm NSAID intake (Huber et al, 1991;Halter et al, 1993;Robinson et al, 1995;Hooker et al, 1996;Abrahamian et al, 1998;Eis et al, 1998;Gopal and Katon, 1999;Weinstock et al, 1999). NSAIDs may exert their deleterious effects on the distal bowel segments through both local and systemic actions.…”

Section: Discussionmentioning

confidence: 99%

Colon perforation with acute peritonitis after taking clindamycin and diclofenac following wisdom tooth removal

Ervens¹,

Schiffmann

Berger

et al. 2004

Journal of Cranio-Maxillofacial Surgery

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“…Infrequent studies similarly show a weak association between dyspepsia and small intestinal lesions (ulcerations of the jejunum and ileum can cause noncharacteristic dyspepsia and abdominal pain). Stenosis can be presented with subsequent passage disorders [12, 31, 32]. On the other hand, the direct effect of NSAIDs on the central nervous system can also induce nonspecific dyspepsia [33].…”

Section: Resultsmentioning

confidence: 99%

NSAID-Induced Enteropathy in Rheumatoid Arthritis Patients with Chronic Occult Gastrointestinal Bleeding: A Prospective Capsule Endoscopy Study

Tachecí

Bradna

Douda

et al. 2013

Gastroenterology Research and Practice

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Background. The purpose of study was to evaluate the diagnostic yield of capsule endoscopy for NSAID-induced enteropathy and clinical, laboratory, and endoscopic characteristics of disease in patients with rheumatoid arthritis. Methods. 37 rheumatoid arthritis patients (30 women; mean age 55) treated with NSAIDs (>1 month), presented with anaemia and/or positive faecal occult blood testing, entered the study and underwent capsule endoscopy (EndoCapsule; Olympus), laboratory tests, and filled in questionnaires. Results. The prevalence of NSAID-induced enteropathy diagnosed by capsule endoscopy was 68% (25/37), classified as mild (red spots or erosions) in 18 (49%), moderate (10–20 erosions) in 4 (11%), and severe enteropathy (>20 erosions or ulcers) in 3 (8%) patients. We did not find statistically significant relationship between the enteropathy and gender, age, haemoglobin, leukocytes, albumin and CRP, or dyspepsia. The difference between subgroups of NSAIDs according to the COX specificity was not statistically significant. Conclusions. Capsule endoscopy is a highly accurate noninvasive method for evaluation of NSAID-induced enteropathy. It was revealed in a substantial section of the patients with rheumatoid arthritis and occult gastrointestinal bleeding, mostly classified as mild damage. No simple clinical or laboratory markers of the presence or severity of NSAID-induced enteropathy were recognised. This trial is registered with DRKS00004940.

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Diaphragm-like Strictures of the Ileum Associated With NSAID Use: A Rare Complication

Cited by 22 publications

References 0 publications

Histopathology of Diaphragm Disease of the Small Intestine

Histopathology of Diaphragm Disease of the Small Intestine

Colon perforation with acute peritonitis after taking clindamycin and diclofenac following wisdom tooth removal

NSAID-Induced Enteropathy in Rheumatoid Arthritis Patients with Chronic Occult Gastrointestinal Bleeding: A Prospective Capsule Endoscopy Study

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