Clinical, endoscopic and pathologic spectrum of non-steroidal anti-inflammatory drug-induced colitis

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for treatment of arthritis and many other painful conditions. These drugs may cause damage not only to the upper gastrointestinal tract but also to the small and large intestine. This prospective study aimed to determine the presence of colonic lesions among 24 patients who were receiving NSAIDs for more than 3 months, and presented with diarrhea, intractable abdominal pain, and lower GI bleeding. Colonoscopy was done and multiple biopsies from different sites in the colon were obtained. Colonoscopy was normal in 11 (45.8%), showed inflammation or superficial ulcers in 7 (29.1%) and solitary or multiple deep ulcers in 6 (25%). Histology showed erosions in 12 (50%) and lymphocytic colitis in 9 (37.5%); histology was normal in 4 (16.6%). NSAID-induced colonic damage may have clinically significant sequel.

Iatrogenic pathology of the intestines

“…NSAIDs are used widely for the treatment of many conditions, including arthritis, and they act by blocking cyclo‐oxygenases 1 and 2 (COX‐1 and COX‐2). The incidence of adverse effects with NSAIDs has been reported to be up to 70% with long‐term treatment, the most common side effects being dyspepsia, nausea and vomiting. The major pathology caused by this group of drugs in the small intestine is ulceration and haemorrhage, more likely with high doses and prolonged use .…”

Severe colitis due to indomethacin suppository

“…Patients with drug induced colitis often present with symptoms that can include abdominal and rectal pain, hematochezia and diarrhea as in our case. Endoscopic and histologic findings are also often nonspecific and may imitate ischemic or inflammatory colitis as in our case (4,5). In the present case, the patient was managed with meselazine enema and showed marked improvement.…”

“…These drugs may cause damage not only to the upper gastroin- testinal tract but also to the small and large intestine (4,5). Colitis induced by indomethacin suppository is a rare condition as in our case.…”

Nichtsteroidale Antirheumatika und Gastrointestinaltrakt

“…In der Histologie fanden sich sowohl Erosionen als auch eine lymphozytäre Ko litis [25]. Eine Studie zeigte, dass bei Patienten mit kollagener Kolitis und mukosalen Läsionen häu fig (77%) eine NSAREinnahme vorliegt [26].…”