Present status and strategy of NSAIDs-induced small bowel injury

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to cause gastroduodenal mucosal lesions as an adverse effect. Recently, the serious problem of NSAID-induced small intestinal damage has become a topic of great interest to gastroenterologists, since capsule endoscopy and balloon enteroscopy are available for the detection of small intestinal lesions. Such lesions have been of great concern in clinical settings, and their treatment and prevention must be devised as soon as possible. The prevalence of NSAIDs-induced small intestinal injury is higher than had been expected. Recent studies show that more than 50% of patients taking NSAIDs have some mucosal damage in the small intestine. The gross appearance of NSAIDinduced enteropathy varies, appearing variously as diaphragm-like strictures, ulcers, erosions, and mucosal redness. To investigate NSAID-induced enteropathy, and to rule out other specific enteropathies, other useful methods (in addition to capsule endoscopy and balloon enteroscopy) include such modalities as radiological examination of the small intestine, the permeability test, scintigraphy or the fecal excretion test using 111 Indium-labeled white blood cells, and measurement of the fecal calprotectin concentration. Diaphragm-like strictures and bleeding from mucosal breaks may be treatable with interventional enteroscopy. Misoprostol, metronidazole, and sulfasalazine are frequently used to treat NSAID-induced enteropathy, but have undesirable effects in some cases. In the experimental model, we confirmed that several existing drugs for gastroduodenal ulcers prevented indomethacin-induced small intestinal injury. Such drugs may be useful for preventing the adverse effects of NSAIDs not only in the stomach but also in the small intestine. We hope to examine these drugs in future clinical studies.

Influence of Helicobacter pylori Infection on the Small Intestinal Mucosa

“…Our results indicated that the incidence of small intestinal mucosal injury tended to be lower in Hp-infected patients than in non-Hp-infected patients. Because aspirin or NSAIDs inhibit cyclooxygenase (COX) and prostaglandin (PG) production at inflamed sites and may increase the risk of mucosal damage in the small intestine [18,19], the incidence of enteritis was determined in patients not receiving aspirin/NSAIDs; the results of this evaluation revealed that the rate of enteritis was significantly lower in the Hp-infected patients than in the Hp-noninfected patients. These findings suggest that H. pylori infection might protect the small intestinal mucosa against injury.…”

Meloxicam-induced enteropathy of the small bowel

“…Recent studies have shown that both isoforms of the COX enzyme (COX-1 and COX-2) play a role in maintaining mucosal integrity of the small intestine. 3 The microcirculatory dysfunction and increase in intestinal motility noted with the use of NSAIDs may also play a contributory role in the development of NSAID-induced enteropathy. 3 Complications NSAID-induced enteropathy often goes undetected because patients are asymptomatic.…”

“…3 The microcirculatory dysfunction and increase in intestinal motility noted with the use of NSAIDs may also play a contributory role in the development of NSAID-induced enteropathy. 3 Complications NSAID-induced enteropathy often goes undetected because patients are asymptomatic. Increased intestinal permeability has been reported to occur as early as 12 hours after a single dose of most conventional NSAIDs.…”

Interaction between C-Reactive Protein and Phytochemical(s) from <i>Calotropis procera</i>: An Approach on Molecular Docking

“…It leads to internal and external inflammation in tissues, organs etc. There are well established anti-inflammatory synthetic drugs, which help as pain killer as well as recovery of swelling in tissues however, may cause side effect like ulcer in gastrointestinal tract [33][34][35][36][37]. Moreover, aqueous flower extract of C. procera has been documented to arrest pain, fever and inflammation [38][39] while ethanolic extract of root bark showed anti-inflammatory properties without any side effect [9,40].…”