NSAID-Induced Enteropathy in Rheumatoid Arthritis Patients with Chronic Occult Gastrointestinal Bleeding: A Prospective Capsule Endoscopy Study

Abstract

Background. The purpose of study was to evaluate the diagnostic yield of capsule endoscopy for NSAID-induced enteropathy and clinical, laboratory, and endoscopic characteristics of disease in patients with rheumatoid arthritis. Methods. 37 rheumatoid arthritis patients (30 women; mean age 55) treated with NSAIDs (>1 month), presented with anaemia and/or positive faecal occult blood testing, entered the study and underwent capsule endoscopy (EndoCapsule; Olympus), laboratory tests, and filled in questionnaires. Results. The prevalence of NSAID-induced enteropathy diagnosed by capsule endoscopy was 68% (25/37), classified as mild (red spots or erosions) in 18 (49%), moderate (10–20 erosions) in 4 (11%), and severe enteropathy (>20 erosions or ulcers) in 3 (8%) patients. We did not find statistically significant relationship between the enteropathy and gender, age, haemoglobin, leukocytes, albumin and CRP, or dyspepsia. The difference between subgroups of NSAIDs according to the COX specificity was not statistically significant. Conclusions. Capsule endoscopy is a highly accurate noninvasive method for evaluation of NSAID-induced enteropathy. It was revealed in a substantial section of the patients with rheumatoid arthritis and occult gastrointestinal bleeding, mostly classified as mild damage. No simple clinical or laboratory markers of the presence or severity of NSAID-induced enteropathy were recognised. This trial is registered with DRKS00004940.

The microbiota-derived metabolite indole decreases mucosal inflammation and injury in a murine model of NSAID enteropathy

“…Indomethacin had a negligible effect on the large intestine (data not shown), consistent with evidence that indomethacin induces small intestinal ulcerations in mice in a location similar to where NSAIDs injure people. [24][25][26][27][28] Indole reduced indomethacin-induced neutrophilic infiltration of spleen and MLN Neutrophilic inflammation is primarily responsible for NSAID enteropathy, therefore, we quantified the abundance of neutrophils in the spleen and MLNs as measures of systemic neutrophilic response and trafficking of neutrophils though the GI tract, respectively. [29][30] Indomethacin treatment resulted in a significant increase in neutrophils (defined as both CD11b-and GR-1 double-positive; Supplementary Fig.…”

Stellenwert der Anämie bei rheumatoider Arthritis

“…Falls sie eine Anämie oder eine okkulte gastrointestinale Blutung aufwiesen, wurde eine Kapselendoskopie durchgeführt. Hier konnte bei 68 % der Patienten eine NSAR-induzierte Enteropathie festgestellt werden [16].…”

Nonsteroidal Anti-inflammatory Drugs, Proton Pump Inhibitors, and Gastrointestinal Injury: Contrasting Interactions in the Stomach and Small Intestine

“…The lesions in the small intestine tend to persist whether NSAID therapy is continued 37 or discontinued. 38 Tachecí et al 37 reported the prevalence of small-bowel enteropathy among patients diagnosed with rheumatoid arthritis and suffering from chronic occult GI bleeding who had been treated for several months with various selective (cyclooxygenase-2) and nonselective (eg, ibuprofen, diclofenac, and ketoprofen) NSAIDs. The prevalence of mucosal lesions in patients treated with NSAIDs A, Pyloric channel ulcer in a patient with rheumatoid arthritis treated with 100 mg of diclofenac daily without regular PPI intake.…”

“…Of interest, no statistically significant difference in prevalence was noted between the various NSAIDs. 37 Similarly, 75% of the patients diagnosed with osteoarthritis receiving chronic NSAID therapy (diclofenac, dexibuprofen, or inbuprofen) and evaluated with CE had mucosal lesions in the small bowel. 38 Leung et al 39 documented that the administration of low-dose acetylsalicylic acid (ASA) resulted in injury to the small-bowel mucosa similar to that observed with NSAIDs.…”