Resolution of Multiple Severe Nonsteroidal Anti-Inflammatory Drug-Induced Colonic Strictures with Prednisone Therapy: A Case Report and Review of the Literature

Abstract

A 69-year-old woman on nonsteroidal anti-inflammatory drugs (NSAIDs) was admitted to a university hospital with abdominal pain, profound anemia and melena stools. Duodenal ulceration and subsequent healing were documented. Colonoscopy revealed haustral ulceration and NSAID-induced colonic diaphragm disease. Discontinuation of NSAID therapy did not result in endoscopic change, but a 20-week course of prednisone was followed by complete resolution. This is the first case describing prednisone monotherapy for such strictures, and only the second in which endoscopic resolution has been documented. With further supporting experience, prednisone may be considered in addition to NSAID discontinuation for patients with this rare but serious complication.

Diaphragmatic disease of the colon: systematic review

“…This action has been shown to resolve the symptoms resulting from inflammation associated with colonic diaphragms within a short period of time . Other medical therapies that showed promising results were steroids and 5‐aminosalicylic acid .…”

Endoscopic and Pathologic Resolution of Chronic Nonsteroidal Anti-Inflammatory Drug-Induced Diaphragm-Like Colonic Strictures and Ulceration

“…The first case of colonic strictures with ulceration was reported in 1989 by Sheers and Williams [ 6 ]. Most diaphragm-like colonic strictures reported in the literature are limited to the right colon (79% of cases), per review by Penner et al [ 7 ].…”

“…The obvious first step in patients with NSAIDs-related colopathy appears to be discontinuation of the offending agent. The review by Penner et al showed nine patients with NSAIDs-related colonic strictures who were managed conservatively by discontinuing the NSAIDs, of which one patient had no follow-up, three became asymptomatic, and four had endoscopic or radiological follow-up that showed no change to the lesions after two weeks, five weeks, 18 months, and two years, respectively [ 7 ]. To the best of our knowledge, our case report presents a unique perspective in management of NSAIDs-related diaphragm-like strictures and ulceration, in which simple discontinuation of the offending agent revealed both clinical improvement and endoscopic and histologic healing.…”

Endoscopic Management of Acute Lower Gastrointestinal Bleeding

“…There is no obvious evidence for the effectiveness of medical treatment in NSAID-induced colopathy. In some case reports, steroids have been used in the treatment of NSAID colonic stricture which failed to resolve after discontinuation of the offending drug [73] .…”