Colonic mucosal lesions associated with long‐term administration of non‐steroidal anti‐inflammatory drugs

Abstract

Summary Background Effects of long‐term administration of non‐steroidal anti‐inflammatory drugs (NSAIDs) on the colon have not been well characterized. Aim To investigate colonoscopic findings and prevalence of adverse events following long‐term use of NSAIDs. Methods The study included 425 patients (mean 66.4 years) treated for over one year with NSAIDs, and 2125 age‐ and sex‐matched patients without NSAIDs as controls. Eligible candidates were selected by medical record review for underlying diseases, pre‐endoscopic symptoms, category of NSAIDs used, and duration of use. We used endoscopy to study lesion characteristics. Results The occurrence rate of colonic lesions or bleeding in the NSAIDs user (13/425, 3.1%) was higher than that in controls (28/2125, 1.3%) (p = 0.017). Colitis was found in 10 of the 13 patients. The sigmoid colon, descending colon or both (70.0%) was commonly involved, and showed segmental ischemic colitis features in 8 of the 13 patients (61.5%). Among these, duration of use ranged from 1‐30 years (mean 7.8). Nine of 13 patients (69.2%) took low‐dose aspirin. Conclusion The prevalence of colonic lesions in long‐term NSAIDs users is much lower than that of upper gastrointestinal side effects, but higher than that of colonic lesions in non‐NSAIDs users. The most common features of NSAIDs‐associated colitis were segmental ischeznia.

Isolated colonic ulcers: Diagnosis and management

“…Most lesions are detected on routine screening examination or on work-up for chronic gastrointestinal blood loss. Terminal ileal ulcers due to NSAID usage have been described in up to 2% of 1900 colonoscopies [1], and this finding is consistent with results from another study describing a 3% occurrence of NSAID-induced colonic lesions in chronic NSAID users [2]. The incidence of colonic ulcers in symptomatic patients is higher; in a large city hospital 10% of patients with acute lower gastrointestinal bleeding were found to have colon ulceration as the cause of the bleeding, and 50% of the patients were consuming NSAIDs [3].…”

“…Colonic involvement is well recognized but rare. In a recent study of 425 patients with chronic NSAID usage, 3% of the patients demonstrated colonic lesions [2]. Longer-acting and enteric-coated NSAIDs are most commonly associated with colonic injury, with injury following diclofenac and enteric-coated aspirin usage the most commonly reported [5].…”

Solitary ulcer in cecum, mimicking a carcinoma: A case report

“…[9], from 425 patients exposed to chronic consumption of NSAIDs found that as many as 3% suffered from colonic lesions. Recently, colonic complications induced by this drug family have garnered some notice but there are very few articles available on the disease [9], [10].…”

“… [9] , from 425 patients exposed to chronic consumption of NSAIDs found that as many as 3% suffered from colonic lesions. Recently, colonic complications induced by this drug family have garnered some notice but there are very few articles available on the disease [9] , [10] . NSAIDs are one of the most prescribed groups of pharmaceuticals in the United States, with an estimated 40 billion pills of aspirin sold in pharmacies each year [10] .…”