Small intestinal injury in NSAID users suffering from rheumatoid arthritis or osteoarthritis

Tachecí, Ilja; Bradna, P; Douda, Tomáš; Baštecká, Drahomíra; Kopáčová, Marcela; Rejchrt, Stanislav; Lutonský, M; Soukup, Tomáš; Bureš, Jan

doi:10.1007/s00296-016-3552-x

Cited by 17 publications

(14 citation statements)

References 14 publications

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“…The cause of ulcerative small intestinal lesions may be NSAIDs, anticoagulants including low-dose aspirin, or an increase in infectious small intestinal disease. 11,12 NSAIDs damage the small intestinal mucosa at a high rate, 13 but no significant difference was noted in our findings.…”

Section: Discussioncontrasting

confidence: 61%

Investigation of small intestinal lesions in dialysis patients using capsule endoscopy

Nakajima

Furumatsu

Yurugi

et al. 2018

Hemodialysis International

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Introduction: Although gastrointestinal hemorrhage is an important complication for dialysis patients, the details of many points remain unclear with regard to small intestinal lesions. Methods: Capsule endoscopy was performed in fecal occult blood‐positive dialysis (n =16) and non‐dialysis (n = 20) patients after upper and lower gastrointestinal endoscopies failed to reveal hemorrhagic lesions. Findings: Erosive lesions were observed in 50.0% (8/16) and 25.0% (5/20) of the dialysis and non‐dialysis groups, respectively. Vascular lesions were observed in 62.5% (10/16) and 25.0% (5/20), respectively. Vascular lesions were observed at a significantly higher rate in the dialysis patients (P = 0.041), but no significant difference was noted in erosive lesions (P = 0.188). Of patients taking proton pump inhibitor (PPI), Non‐Steroidal Anti‐Inflammatory Drugs, and antiplatelet drugs, only oral PPI administration was associated with vascular lesions (P = 0.02). Discussion: In dialysis patients, vascular lesions are the most common among small intestinal lesions, suggesting that they may have caused previously unexplained gastrointestinal hemorrhage in dialysis patients. It was also suggested that the frequent use of PPI may be a cause of small intestinal lesions.

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Section: Discussioncontrasting

confidence: 61%

Investigation of small intestinal lesions in dialysis patients using capsule endoscopy

Nakajima

Furumatsu

Yurugi

et al. 2018

Hemodialysis International

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“…Reports have shown that approximately 1% of the world population is suffering from RA and that OA affects mainly the elderly 2,3. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to be widely used in RA and OA therapy 4,5. However, NSAIDs can induce renal and gastrointestinal toxicities because they inhibit prostaglandin synthesis, thus limiting the clinical application of NSAIDs 6.…”

Section: Introductionmentioning

confidence: 99%

Controlled release of optimized electroporation enhances the transdermal efficiency of sinomenine hydrochloride for treating arthritis in vitro and in clinic

Feng¹,

Zhu²,

Huang³

et al. 2017

DDDT

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Sinomenine hydrochloride (SH) is an ideal drug for the treatment of rheumatoid arthritis and osteoarthritis. However, high plasma concentration of systemically administered SH can release histamine, which can cause rash and gastrointestinal side effects. Topical delivery can increase SH concentration in the synovial fluid without high plasma level, thus minimizing systemic side effects. However, passive diffusion of SH was found to be inefficient because of the presence of the stratum corneum layer. Therefore, an effective method is required to compensate for the low efficiency of SH passive diffusion. In this study, transdermal experiments in vitro and clinical tests were utilized to explore the optimized parameters for electroporation of topical delivery for SH. Fluorescence experiment and hematoxylin and eosin staining analysis were performed to reveal the mechanism by which electroporation promoted permeation. In vitro, optimized electroporation parameters were 3 KHz, exponential waveform, and intensity 10. Using these parameters, transdermal permeation of SH was increased by 1.9–10.1 fold in mice skin and by 1.6–47.1 fold in miniature pig skin compared with passive diffusion. After the electroporation stimulation, the intercellular intervals and epidermal cracks in the skin increased. In clinical tests, SH concentration in synovial fluid was 20.84 ng/mL after treatment with electroporation. Therefore, electroporation with optimized parameters could significantly enhance transdermal permeation of SH. The mechanism by which electroporation promoted permeation was that the electronic pulses made the skin structure looser. To summarize, electroporation may be an effective complementary method for transdermal permeation of SH. The controlled release of electroporation may be a promising clinical method for transdermal drug administration.

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“…The lesions were mostly mild (36.4%), less frequently moderate (3.5%), or severe (4.9%). 22 VCE showed a high (~70%) rate of small bowel abnormality in chronic NSAID users (> 3 months); 50% patients had mild and 25% of the patients. 23 While VCE is highly sensitive for mucosal lesions, the relevance of these findings is difficult to establish.…”

Section: Endoscopic Studiesmentioning

confidence: 95%

NSAID Enteropathy: A Review of the Disease Entity and Its Distinction from Crohn’s Enteropathy

Raju

Singh

Raju

2019

Journal of Gastrointestinal and Abdominal Radiology

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Nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy is an increasingly recognized entity. Patients of older age and those suffering from conditions such as arthritis requiring long term NSAIDs are thought to be at greater risk. Introduction of enteroscopic techniques has greatly improved understanding of NSAID-related small intestinal injury. Complementary high-resolution cross-sectional imaging techniques aid in initial evaluation and for exclusion of alternative etiology. Erosions, superficial ulcerations, and short segment strictures are the most commonly described findings. The diagnosis of the condition lies in obtaining relevant history in addition to a high degree of suspicion during investigation of anemia, obscure gastrointestinal bleeding, small bowel obstruction, and protein losing enteropathy. Herein, the authors present a review of pathogenesis and imaging findings of NSAID enteropathy with particular emphasis on distinction from Crohn’s enteropathy.

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Small intestinal injury in NSAID users suffering from rheumatoid arthritis or osteoarthritis

Cited by 17 publications

References 14 publications

Investigation of small intestinal lesions in dialysis patients using capsule endoscopy

Investigation of small intestinal lesions in dialysis patients using capsule endoscopy

Controlled release of optimized electroporation enhances the transdermal efficiency of sinomenine hydrochloride for treating arthritis in vitro and in clinic

NSAID Enteropathy: A Review of the Disease Entity and Its Distinction from Crohn’s Enteropathy

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