Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

Hayashi, Yoshikazu; Yamamoto, Hironori; Kita, Hiroto; Sunada, Keijiro; Satō, Hiroyuki; Yano, Tomonori; Iwamoto, Michiko; Sekine, Yutaka; Miyata, Tomohiko; Kuno, Akiko; Iwaki, Takaaki; Kawamura, Yoshiyuki; Ajibe, Hironari; Ido, Kenichi; Sugano, Kentaro

doi:10.3748/wjg.v11.i31.4861

Cited by 56 publications

(37 citation statements)

References 21 publications

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“…However, we cannot check the improvement in endoscopic findings after cessation of NSAIDs because long-term cessation of NSAIDs is frequently impossible for patients with chronic pain or antiplatelet therapy. In the respect of endoscopic findings, those of BE in NSAIDs enteropathy have been variously described as reddish erosions [41,42], sharply demarcated ulcers in multiplicity [41,42], or concentric stenoses [43]. In the JSE-DBE database [14], multiple and discrete ulcers were the most frequent and they were found in 28% of patients in the NSAID group.…”

Section: Diagnosis Of Nsaids-induced Small Intestinal Injurymentioning

confidence: 99%

Present status and strategy of NSAIDs-induced small bowel injury

et al. 2009

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Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to cause gastroduodenal mucosal lesions as an adverse effect. Recently, the serious problem of NSAID-induced small intestinal damage has become a topic of great interest to gastroenterologists, since capsule endoscopy and balloon enteroscopy are available for the detection of small intestinal lesions. Such lesions have been of great concern in clinical settings, and their treatment and prevention must be devised as soon as possible. The prevalence of NSAIDs-induced small intestinal injury is higher than had been expected. Recent studies show that more than 50% of patients taking NSAIDs have some mucosal damage in the small intestine. The gross appearance of NSAIDinduced enteropathy varies, appearing variously as diaphragm-like strictures, ulcers, erosions, and mucosal redness. To investigate NSAID-induced enteropathy, and to rule out other specific enteropathies, other useful methods (in addition to capsule endoscopy and balloon enteroscopy) include such modalities as radiological examination of the small intestine, the permeability test, scintigraphy or the fecal excretion test using 111 Indium-labeled white blood cells, and measurement of the fecal calprotectin concentration. Diaphragm-like strictures and bleeding from mucosal breaks may be treatable with interventional enteroscopy. Misoprostol, metronidazole, and sulfasalazine are frequently used to treat NSAID-induced enteropathy, but have undesirable effects in some cases. In the experimental model, we confirmed that several existing drugs for gastroduodenal ulcers prevented indomethacin-induced small intestinal injury. Such drugs may be useful for preventing the adverse effects of NSAIDs not only in the stomach but also in the small intestine. We hope to examine these drugs in future clinical studies.

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Section: Diagnosis Of Nsaids-induced Small Intestinal Injurymentioning

confidence: 99%

Present status and strategy of NSAIDs-induced small bowel injury

et al. 2009

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“…Histologically, they are characterized by sub-mucosal fibrosis with normal overlying epithelium, apart from the tip of diaphragm, which may be ulcerated; the mucosa between diaphragms is normal [14,45] . Capsule endoscopy, double-balloon enteroscopy and colonoscopy may help in the diagnosis of NSAIDinduced injury, although there is nothing endoscopically specific about NSAID-induced gut lesions [46,47] . Histology is also nonspecific; the differential diagnosis should include: Campylobacter, Yersinia, Cytomegalovirus, TB infections, IBD, ischemia, radiation enteritis, vasculitides and other drugs.…”

Section: Nsaids Related Intestinal Iniurymentioning

confidence: 99%

Gastrointestinal lesions associated with spondyloarthropathies

Orlando

Renna²,

Perricone³

et al. 2009

WJG

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Subclinical gut inflammation has been described in up to two-thirds of patients with spondyloarthropathies (S pA). Ar t hr i t is represents an extra-intestinal manifestation of several gastrointestinal diseases, including inflammatory bowel disease (IBD), Whipple's disease, Behcet's disease, celiac disease, intestinal bypass surgery, parasitic infections of the gut and pseudomembranous colitis. Moreover about twothirds of nonsteroidal anti-inflammatory drug users demonstrate intestinal inflammation. Arthritis may manifest as a peripheral or axial arthritis. The spondyloarthropathy family consists of the following entities: ankylosing spondylitis, undifferentiated s p o n d y l o a r t h r i t i s , r e a c t i ve a r t h r i t i s , p s o r i a t i c arthritis, spondyloarthritis associated with IBD, juvenile onset spondyloarthritis. This topic reviews the major gastrointestinal manifestations that can occur in patients with SpA and in nonsteroidal antiinflammatory drugs users.

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“…Capsule endoscopy (CE) and double-balloon endoscopy (DBE) are diagnostic methods for visualizing small intestinal lesions [4]. In the DBE group, out of 61 patients, ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively [4]. In the cases indicated for enteroscopy, NSAIDs enteropathy occurred in half of the patients taking NSAIDs [7].…”

Section: Introductionmentioning

confidence: 99%

“…(Table 1) NSAID can affect the jejunum and ileum [6]. Capsule endoscopy (CE) and double-balloon endoscopy (DBE) are diagnostic methods for visualizing small intestinal lesions [4]. In the DBE group, out of 61 patients, ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively [4].…”

Section: Introductionmentioning

confidence: 99%