Faecal calprotectin: A simple method for the diagnosis of NSAID-induced enteropathy

Tibble, J; Foster, RG; Sigthorsson, G; Scott, David; Røseth, Arne; Bjarnason, I

doi:10.1016/s0016-5085(98)81259-6

Cited by 5 publications

(6 citation statements)

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“…The long-term studies in patients (usually with rheumatoid arthritis or osteoarthrosis) assess the damage after 3 or more months of ingestion. The small bowel data in these studies conform to what is seen in the short-term (Tibble et al 1999), but there is no clear hierarchy in the order of the gastroduodenal damage caused by these drugs with prevalence of ulcers (almost always defined endoscopically on their size, defined as mucosal break of 3 or 5 mm or greater and with a depth) variably reported between 15 and 35% (Fenn 1994). Data analyses show that there are no specific risk factors to the small bowel damage, but Helicobacter pylori and advancing age may increase the prevalence of the gastroduodenal ulcers (Moore et al 2009).…”

supporting

confidence: 82%

Serious upper gastrointestinal complications of NSAIDs and COX-2 selective agents

Sisson

Bjarnason

2011

Inflammopharmacol

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supporting

confidence: 82%

Serious upper gastrointestinal complications of NSAIDs and COX-2 selective agents

Sisson

Bjarnason

2011

Inflammopharmacol

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“…NSAIDs increase intestinal permeability within hours of ingestion (21) and inflammation is evident with the use of faecal calprotectin or capsule enteroscopy (22) within a week of continuous intake. All conventional NSAIDs seem to be associated with the same prevalence (70%) and severity of enteropathy when taken long term (23). This inflammation may be asymptomatic or lead to symptoms similar to irritable bowel syndrome.…”

Section: Small Bowelmentioning

confidence: 99%

Gastrointestinal safety of NSAIDs and over-the-counter analgesics

Bjarnason

2012

International Journal of Clinical Practice

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Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used. It is well recognised that they may adversely cause damage throughout the gastrointestinal tract and aggravate pre-existing disease. Their side effects on the upper gastrointestinal tract can be assessed by various means; each study type has different clinical connotations. Short-term use (less than 14 days) demonstrates dose-dependent damage of prescribed NSAIDs; the damage is proportional to the acidity of the drugs and not seen with Cyclooxygenase-2 (COX-2) selective inhibitors that have a pKa over 7.0. There have not been any serious outcomes, such as bleeding or perforation in these studies, and Helicobacter pylori (HP) plays no role in this damage. Long-term (3 months or more) endoscopy studies in patients show ulcer rates from 15%-35% with the various NSAIDs, but serious outcomes are exceedingly rare. Epidemiological studies show an association between NSAID intake and serious events. Ibuprofen is consistently at the lower end of toxicity rankings, whereas ketorolac and azapropazone are the worst. The risk of bleeding is increased with advancing age, presence of HP, previous history of bleeding, anticoagulant use, etc. The mega-trials show that COX-2 selective agents halve the bleeding episodes, but NSAID-induced gastric bleeding is very rare usually, less than 1 in 200 subjects taking them for a year. Seventy percent of patients develop NSAID-enteropathy, which is associated with intestinal blood and protein loss and rarely strictures. Over-the-counter (OTC) use of ibuprofen and diclofenac is associated with symptomatic gastrointestinal side effects comparable with placebo. Ibuprofen is shown to be remarkably well tolerated at OTC doses in a number of studies. There are recent studies to suggest that OTC NSAIDs should be taken on a fasting stomach, not with food as commonly advocated.

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“…One such is the faecal calprotectin test whereby intestinal inflammation is quantitated by measurement of a neutrophil selective marker, calprotectin. This protein resists degradation by intestinal bacteria and the values correlate significantly with the faecal 111Indium white-cell faecal excretion (25). The faecal calprotectin test has been performed with different extraction buffers that give different absolute but identical relative values in diseases.…”

Section: Intestinal Inflammationmentioning

confidence: 99%

“…The main neutrophil chemoattractant in man appears to be a commensal anaerobic microbe (133). The prevalence and severity of permeability changes and NSAID-enteropathy in man does not differ significantly between the different drugs (25,31).…”

Section: Nsaidsmentioning

confidence: 99%

The G.U.T. of gut

Bjarnason¹,

Takeuchi²,

Bjarnason³

et al. 2004

Scandinavian Journal of Gastroenterology

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Scand J Gastroenterol 2004;39:807-815. Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14 For personal use only. Current Opinion Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14 For personal use only. Scand J Gastroenterol 2004 (9) 810 Current Opinion Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14 For personal use only. Scand J Gastroenterol 2004 (9) Current Opinion 811 Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14 For personal use only. Scand J Gastroenterol 2004 (9) 812 Current Opinion Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14 For personal use only. Current Opinion Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14For personal use only. Current Opinion 815Scand J Gastroenterol Downloaded from informahealthcare.com by The University of Manchester on 11/26/14For personal use only.

show abstract

Faecal calprotectin: A simple method for the diagnosis of NSAID-induced enteropathy

Cited by 5 publications

References 0 publications

Serious upper gastrointestinal complications of NSAIDs and COX-2 selective agents

Serious upper gastrointestinal complications of NSAIDs and COX-2 selective agents

Gastrointestinal safety of NSAIDs and over-the-counter analgesics

The G.U.T. of gut

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