Case report: Radiological appearance of colonic stricture associated with the use of nonsteroidal anti-inflammatory drugs

Resolution of Multiple Severe Nonsteroidal Anti-Inflammatory Drug-Induced Colonic Strictures with Prednisone Therapy: A Case Report and Review of the Literature

“…The literature available demonstrates that patients left with unhealed strictures can develop severe consequences in the form of obstruction or later requirement for surgical therapy (12,26). Furthermore, the follow-up of patients treated conservatively or endoscopically generally reveals no change in their lesions (9,14,15,25). The only previously published case of endoscopic resolution of NSAID-induced colonic strictures followed prednisone therapy after colonic dilation (20), and the case presented here is a successful first trial of prednisone monotherapy.…”

“…Publications on eight of the 33 previous cases provide no details on treatment or follow-up (5,12,24). Twelve cases were managed with surgical resection (7,8,11,13,(15)(16)(17)(18)23,26); four with endoscopic dilation (19)(20)(21) and nine were managed conservatively by discontinuing NSAID therapy as the sole therapeutic maneuver (6,9,10,12,14,15,22,25).…”

“…Of the nine patients managed conservatively by discontinuing NSAID therapy, one had no follow-up (6), three became asymptomatic and had no further follow-up (10,12,22), four had endoscopic or radiological follow-up indicating no change to the lesions (after two weeks, five weeks, 18 months and two years, respectively) (9,14,15,25) and one developed an obstruction relating to the lesion after three months of follow-up (12).…”

“…A paucity of published literature exists on NSAID-associated colonic diaphragms, with only 33 cases reported in the English literature . Case reports have previously documented symptomatic resolution after the discontinuation of NSAID therapy (10,12,15,22,26), after endoscopic dilation (19,21) or after colonic resection (7,8,11,13,(15)(16)(17)(18)23,26), but data on followup colonoscopy or radiology after medical or conservative management is available in only five cases (9,14,15,20,25). Complete healing of diaphragms has been documented only once (20).…”