Colonic diaphragms associated with long-term use of nonsteroidal antiinflammatory drugs.

Spirnak, J. Patrick; Monahan, David W.

doi:10.2214/ajr.160.5.8470601

Cited by 7 publications

(17 citation statements)

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“…Several other authors also have reported observing, during endoscopic examination [12][13][14][15] or after laparotomy, [16][17][18][19][20][21] the presence of diaphragmlike lesions in the small or large intestine or both of patients taking NSAIDs. Huber et al 12 described a 61-year-old man, taking NSAIDs, who had iron deficiency anemia and obscure GI bleeding.…”

Section: Discussionmentioning

confidence: 99%

Diaphragm Disease After Use of Nonsteroidal Anti-inflammatory Agents

Yousfi¹,

Petris²,

Leighton³

et al. 2004

Journal of Clinical Gastroenterology

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Diaphragm disease of the small intestine is part of the spectrum of diseases associated with injury to the gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs. Standard endoscopy or contrast studies of the small intestine rarely identify these lesions. The diagnosis usually is established at the time of surgery. We report the case of a 72-year-old woman with obscure gastrointestinal bleeding and intermittent obstruction of the small intestine who had had multiple hospitalizations and extensive testing. The patient had been treated with nonsteroidal anti-inflammatory drugs for osteoarthritis. A radiograph of the small intestine with barium contrast revealed no abnormalities, so capsule endoscopy was performed. Capsule endoscopy showed multiple small intestinal strictures beyond which the capsule could not pass. After the patient experienced continued symptoms suggestive of intermittent partial obstruction of the small intestine, computed tomography showed the capsule within a dilated loop of intestine adjacent to a stricture. After 9 days of conservative medical therapy and worsening symptoms, the patient required an exploratory laparotomy. The capsule was located in a 12-cm segment of intestine with 4 diaphragm-like lesions. Pathologic study found submucosal lesions with features identical to those of neuromuscular and vascular hamartoma (eg, mature, reactive tissue elements of smooth muscle, dense fibrous tissue, and nerve tissue bundles with scattered ganglion cells and vessels). No manifestations of Crohn disease were evident. This case represents the first diagnosis with capsule endoscopy of diaphragm disease of the small intestine with pathologic features of neuromuscular and vascular hamartoma.

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Section: Discussionmentioning

confidence: 99%

Diaphragm Disease After Use of Nonsteroidal Anti-inflammatory Agents

Yousfi¹,

Petris²,

Leighton³

et al. 2004

Journal of Clinical Gastroenterology

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“…There is no definitive diagnostic test for this condition, although colonoscopy is the best investigative modality as ulceration and the diagnostic diaphragm strictures are more easily recognized 33 . These diaphragm strictures have also been demonstrated on contrast enemas, 34 although contrast studies can be falsely negative 35 …”

Section: Clinical Presentationmentioning

confidence: 99%

“…While ulcers are likely to resolve, strictures sometimes may persist in spite of cessation of the NSAIDs. In such cases, surgical resection of the diseased segment may be necessary 32–34 . All the 13 patients in the cohort described by Kurahara and colleagues with uncomplicated ulceration without stricture healed up on repeat colonoscopy at 3–10 weeks after withdrawal of the NSAIDs.…”

Section: Managementmentioning

confidence: 99%

“…These include balloon dilatation 37 and prednisolone therapy 38 . If there is doubt about the aetiology of strictures after thorough investigations or if they are causing obstructive symptoms, then surgical excision is indicated 32–34 …”

Section: Managementmentioning

confidence: 99%

“…24 Diaphragm-like strictures are pathognomonic for this condition and are thought to be the result of prolonged ulceration. 8,21,34 . A few weeks after discontinuing NSAIDs, ulcers usually heal with evidence of minimal scarring, while in some occasions, mucosal inflammation can still be evident on colonoscopy.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Nonsteroidal anti‐inflammatory drugs‐associated colopathy

Masannat

Harron

Harinath

2010

ANZ Journal of Surgery

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NSAIDs colopathy is a rare benign condition. Current evidence only suggests an association with prolonged use of the NSAIDs, however, there are no studies to support the direct causation. The presentation is non-specific, and the commonest findings on endoscopy are ulceration and diaphragm-like strictures. The importance of identifying this condition is to prevent complications and also to be able to differentiate it from other conditions such as inflammatory bowel disease (IBD) and malignancy.

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