NSAID injury to the small intestine

Abstract

Multiple diaphragm-like strictures can occur in NSAID injury and are pathognomonic except in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID injury and peptic ulceration. ASA should be considered an NSAID with regard to small-bowel toxicity. A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, and a dedicated small bowel examination is required when NSAID injury is suspected.

Randomized, double-blind, pilot study of geranylgeranylacetone versus placebo in patients taking low-dose enteric-coated aspirin. Low-dose aspirin-induced small bowel damage

“…Non-steroidal anti-inflammatory drugs (NSAIDs) are known to cause small bowel and colonic damage [1], including bleeding and protein loss, which may result in iron-deficiency anemia and/or hypoalbuminemia. However,the prevalence ofactualclinical small bowel adverse effects causedby aspirinremains unclear.…”

Double-Contrast Barium Enteroclysis as a Patency Tool for Nonsteroidal Anti-Inflammatory Drug-Induced Enteropathy

“…Zalev et al [22] analyzed four symptomatic cases of diaphragms and found that lifesaver-like stricture and babel-like configuration were depited by small bowel radiography. Although those descriptions were heterogeneous with regards to the width of the narrow septae, they are in concert with respect to concentric and multiple stenoses [19][20][21][22]. Our results indicated that the circular ulcers, as well as diaphragms, were depicted as apparently normal folds when the affected small bowel was insufflated with an appropriate amount of air under DCBE.…”

“…In the literature, the radiographic features of NSAIDinduced diaphragms have been discussed in symptomatic patients who were examined by barium follow-through study [19,21,22]. Zalev et al [22] analyzed four symptomatic cases of diaphragms and found that lifesaver-like stricture and babel-like configuration were depited by small bowel radiography.…”

“…However, the patency system is time-consuming, requiring 5 days for final decisions at most [18]. Furthermore, it is a historical fact that diaphragms could be diagnosed by small bowel radiography in the 1990s [19][20][21][22]. We thus made a retrospective analysis of our patients with endoscopically diagnosed NSAID enteropathy to assess the role of double-contrast barium enteroclysis as a procedure for luminal patency in the disease.…”

Low-Dose Aspirin and Small Bowel Enteropathy: Mountain or Molehill?

“…Aspirin was reported to be associated with an increased risk of lower gastrointestinal bleeding in 7 out of 8 case-control studies [7] , but a large-scale 48-month trial failed to demonstrate such an effect [8] . Aspirin's small bowel effects were evaluated at enteroscopy, surgery or post-mortem, suggesting an increased risk for perforation and bleeding [9,10] . Diaphragm-like strictures in the small bowel were reported in long-term aspirin users [11] .…”