Perforación ileal por indometacina

Cernuda, R Baldonedo; Pérez, Julio C.; Bear, I. García; Alonso, Noelia; Barreiro, JI Jorge

doi:10.1157/13056031

Cited by 1 publication

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“…There is no significant correlation between the type of small bowel lesions and particular clinical manifestation (73) except diaphragmatic disease (5,6,40,91). Diaphragm-like small intestinal strictures are a rare but very typical (pathognomonic) sign of NSAID-induced injury to the small bowel.…”

Section: E) Small Intestinal Perforation and Obstructionmentioning

confidence: 99%

Non-steroidal Anti-inflammatory Drug Induced Injury to the Small Intestine

Tachecí

Kopáčová

Rejchrt

et al. 2010

Acta Med. (Hradec Kralove, Czech Repub.)

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Non-steroidal anti-inflammatory drugs (NSAIDs) represent the group of most commonly used drugs worldwide. The target group for use of NSAIDs comprises the elderly population with higher morbidity and mortality and a higher risk of drug toxicity (91). This fact together with the aging of the population in developed countries means increasing medical and economical problems in this context. In a large prospective analysis of adverse drug reactions in 18,820 patients in the United Kingdom, NSAIDs were responsible for 1.9 % (363) of all hospital admissions (29.6 % of all drug-related adverse events) in the period of time studied (67). The most frequent were gastrointestinal, nervous system, renal, and allergic adverse effects. Gastrointestinal toxicity is widely recognised, especially in the gastroduodenal area.Over the past decade, an increasing quantity of data has been gathered documenting small bowel involvement and its importance, showing its previous underestimation. This is related to advancements in small bowel evaluation, especially in small bowel endoscopy. The goal of this review is to discuss current knowledge of the range of NSAID-induced small intestinal injury, its clinical features, diagnosis and management. HistoryThe first description of NSAID (aspirin)-induced gastropathy identified by endoscope was presented by Douthwaite and Lintott in 1938 (22). Small bowel damage due to indomethacin management was observed for the first time in humans in the 70s (80). Many cases of small bowel perforation (65) and other clinical manifestations of small bowel enteropathy were published (7,8,9,10,11,12,56) in the 80s. Most morphology data were acquired from autopsy (4) and surgical studies at that time (57). Because of the relative inaccessibility of the small intestine, initial endoscopy data were drawn from sonde enteroscopy, and were not published until the early 90s (64). The capsule endoscopy era begins in the year 2000 (44) and is linked with an information boom concerning NSAID-induced enteropathy. EpidemiologyAccording to the data published in the ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) database, up to 1.3 % of patients treated with NSAIDs are hospitalised for severe gastrointestinal complications in the USA and Canada, a 1-year mortality rate is seen in about 0.11-0.22 % in this population (75). Summary: Non-steroidal anti-inflammatory drug (NSAIDs) induced enteropathy represents an important complication of one of the most commonly used drugs worldwide. Due to previous diagnostics difficulties the real prevalence of this disease was underestimated for a long time. The pathogenesis of NSAID-enteropathy is more multifactorial and complex than formerly assumed but has still not been fully uncovered. A combination of the local and systemic effect plays an important role in pathogenesis. Thanks to novel enteroscopy methods (wireless capsule endoscopy, double balloon enteroscopy), small bowel lesions are described in a substantial section of NSAID users although most are clinical...

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Section: E) Small Intestinal Perforation and Obstructionmentioning

confidence: 99%