Prevention and management of non-steroidal anti-inflammatory drugs-induced small intestinal injury

Park, Sung Chul; Chun, Hoon Jai; Kang, Chang Don; Sul, Donggeun

doi:10.3748/wjg.v17.i42.4647

Cited by 72 publications

(68 citation statements)

References 52 publications

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“…NSAID-induced enteropathy and bleeding occur more frequently that NSAID-induced gastropathy [2,3] . Significant small intestinal damage and bleeding can be observed in about 70% of chronic NSAID users [4,5] , and in the majority of patients the injury is sub-clinical [6] . Unlike the case for NSAID-gastropathy, there are no proven-effective preventative therapies for NSAIDenteropathy, and the pathogenesis is poorly understood [7] .…”

Section: Overview Of the Clinical Problemmentioning

confidence: 99%

“…Unlike the case for NSAID-gastropathy, there are no proven-effective preventative therapies for NSAIDenteropathy, and the pathogenesis is poorly understood [7] . Iron-deficient anemia is a common first presentation of NSAID-enteropathy, and serious complications can include massive bleeding, perforation and strictures, sometimes leading to death [2,6,8] .…”

Section: Overview Of the Clinical Problemmentioning

confidence: 99%

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Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Wallace¹

2013

WJG

151

148

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This article reviews the latest developments in understanding the pathogenesis, detection and treatment of small intestinal damage and bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs). With improvements in the detection of NSAID-induced damage in the small intestine, it is now clear that this injury and the associated bleeding occurs more frequently than that occurring in the stomach and duodenum, and can also be regarded as more dangerous. However, there are no proven-effective therapies for NSAIDenteropathy, and detection remains a challenge, particularly because of the poor correlation between tissue injury and symptoms. Moreover, recent studies suggest that commonly used drugs for protecting the upper gastrointestinal tract (i.e. , proton pump inhibitors) can significantly worsen NSAID-induced damage in the small intestine. The pathogenesis of NSAIDenteropathy is complex, but studies in animal models are shedding light on the key factors that contribute to ulceration and bleeding, and are providing clues to the development of effective therapies and prevention strategies. Novel NSAIDs that do not cause small in- FRONTIER

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Section: Overview Of the Clinical Problemmentioning

confidence: 99%

Section: Overview Of the Clinical Problemmentioning

confidence: 99%

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Wallace¹

2013

WJG

151

148

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“…Often, these may be provided for a concomitant or a related disorder. For example, non-steroidal anti-inflammatory drugs (NSAIDs) [45] are often used in patients with ankylosing spondylitis or other arthropathy associated with inflammatory bowel disease. Sometimes, these agents have been associated with a wide range of small intestinal pathological changes, including ulceration and stricture formation that, in some instances, may be even difficult to distinguish from an underlying intestinal disorder, such as CD.…”

Section: Medication-related Causesmentioning

confidence: 99%

Spontaneous free perforation of the small intestine in adults

Freeman¹

2014

WJG

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“…As regards small bowel diaphragms produced by NSAIDs, this has resulted in the retention of the videocapsule at a rate of 1.1% in 1,000 patients with various indications for examination with endoscopic videocapsule analyzed in a retrospective study [16]. Characteristic diaphragm-like strictures are said to be a result of chronic ulcers caused by NSAID, and in this regard it has been reported that 17% of patients with NSAID-induced small bowel ulcers can develop such stenoses [17]. On the other hand, the rate of non-excretion was zero in healthy asymptomatic volunteers [18].…”

Section: Discussionmentioning

confidence: 99%

Is the use of AGILE patency capsule prior to videocapsule endoscopy useful in all patients with spondyloarthritis?

Gheorghe

Zahiu

Voiosu

et al. 2017

Romanian Journal of Internal Medicine

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Background and aims. As already known, spondyloarthritis patients present a striking resemblance in intestinal inflammation with early Crohn's disease. Moreover, the frequent use of nonsteroidal anti-inflammatory drugs is an important part of their treatment. Both conditions could lead to intestinal stenoses. Therefore we proposed to investigate the usefulness of the patency capsule test in patients with spondyloarthritis.Material and methods. 64 consecutive patients (33 males; mean age 38 ± 11 years) that fulfilled the AMOR criteria for seronegative spondyloarthropathy (59.4% ankylosing spondylitis) lacking symptoms or signs of intestinal stenosis were enrolled and submitted to an AGILE™ capsule patency test followed by a video capsule endoscopy (PillCam SB2™), as part of a protocol investigating the presence of intestinal inflammatory lesions. After reviewing the VCE recordings, the Lewis score (of small bowel inflammatory involvement) was computed.Results. In only 5 patients (7.8%) of the study group, the luminal patency test was negative. However, there was no retention of the videocapsule in any of the patients. From the 59 patients with a positive patency test, 3 patients presented single small bowel stenoses (two with ulcerated overlying inflamed mucosa, one cicatricial), all being traversed by the videocapsule along the length of the recording. None of the patients with a negative test had bowel stenoses. There was no correlation between the patency test and the Lewis score, the C reactive protein value, diagnosis of inflammatory bowel disease, or the family history of spondyloarthritis, psoriasis or inflammatory bowel disease.Conclusion. The AGILE patency capsule does not seem to be a useful tool for all patients with spondyloarthritis prior to small bowel videocapsule endoscopy (ClinicalTrial.gov ID NCT 00768950).

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Prevention and management of non-steroidal anti-inflammatory drugs-induced small intestinal injury

Cited by 72 publications

References 52 publications

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Spontaneous free perforation of the small intestine in adults

Is the use of AGILE patency capsule prior to videocapsule endoscopy useful in all patients with spondyloarthritis?

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