doscopy. However, recent advances in diagnostic devices used to look at the small intestine, such as capsule endoscopy (CE) and double balloon endoscopy (DBE), enabled direct visualization of the small bowel, and revealed the small bowel injuries induced by NSAIDs. [3][4][5][6][7] reported that small bowel damage was found in 71% of chronic NSAID users. However, unlike the NSAID-induced gastropathy, the symptoms of NSAID-induced enteropathy are non-specific and the pathogenesis is poorly understood. Additionally, there is no proven effective treatment or prevention for NSAID-induced enteropathy. Therefore, studies to investigate the mechanism of NSAIDinduced enteropathy and treatment modalities for small bowel damage should be performed in the future. In this paper, we intend to describe the current status of small bowel injuries caused by NSAIDs.
EPIDEMIOLOGYOver the last 10 years, there has been a progressive trend in overall GI complications, such as bleeding and perfora-
INTRODUCTIONNon-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly prescribed drugs in the world. As a result of their anti-inflammatory, analgesic, and antiplatelet effects, NSAIDs are used in clinical practice for treatment and prevention of rheumatoid arthritis, osteoarthritis, collagen disease, and ischemic cardiovascular or cerebrovascular disease. However, NSAIDs are well known to increase the risk of serious gastroduodenal complications, such as peptic ulcer, bleeding, and perforations.
Non-steroidal anti-inflammatory drug-induced enteropathySung Jae Shin, Choong-Kyun Noh, Sun Gyo Lim, Kee Myung Lee, Kwang Jae Lee
Department of Gastroenterology, Ajou University School of Medicine, Suwon, KoreaNon-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.