Strictures, diaphragms, erosions or ulcerations of ischemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drug-induced lesions

A 48-year-old woman presented with a 2-week history of diarrhoea and abdominal pain. No overt gastrointestinal bleeding was reported and there was no history of loss of weight or loss of appetite. General and abdominal examination was unremarkable except for subconjunctival pallor. The haemoglobin was 7.1 g/dl at presentation with the peripheral blood film indicating iron deficiency anaemia. An urgent colonoscopy revealed two strictures within a 5 cm segment of transverse colon. The distal stricture showed significant ulceration and inflammation, while the proximal one showed an impassable "diaphragm-like" stricture. Biopsies from both of the strictures showed chronic inflammatory infiltrate with numerous eosinophils and no evidence of malignancy. The patient had been taking enteric-coated diclofenac tablets 50 mg three times daily over the past 10 years for chronic backache. Her bowel symptoms resolved significantly within 4 weeks of stopping diclofenac and she continued to remain relatively asymptomatic at 3 months follow-up.

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“…Colonic diaphragm-like strictures result from chronic use of sustained-release NSAIDs 1. NSAID-induced strictures were first described in 1989 2.…”

Section: Discussionmentioning

confidence: 99%

NSAIDs-induced diaphragm-like colonic strictures: a case report

Hakeem

Subramonia²,

Badrinath³

et al. 2009

Case Reports

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“…Although Goldstein and Cinenza reported that none of their biopsy specimens from patients with NSAID-associated colitis showed histological features of ischemia [29], Yao et al reported one case of ischemic colitis identified by histopathological examination of NSAID-associated colitis [30]. Stolte et al reported no observable histological differences between NSAID ⁄ aspirin-induced lesions and ischemic lesions [24]. In the present study, because treatment with low-dose aspirin was not discontinued prior to undergoing colonoscopy in most cases, biopsy specimens were not taken during colonoscopy from patients treated with low-dose aspirin, as stipulated in the Japanese Guidelines for Prevention of Accidents during Colonoscopic Procedures.…”

Section: Discussionmentioning

confidence: 99%

Colonic mucosal lesions associated with long‐term or short‐term administration of nonsteroidal anti‐inflammatory drugs

et al. 2009

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“…Sie in hibieren die Prostaglandinsynthese durch Hemmung der Zyklooxygenase und entkoppeln die mi tochondriale oxidative Phosphorylierung. Es kommt zu einer Verringerung von Adenosintriphos phat (ATP), zur Schädigung intrazellulärer Bindungen [3,4,5] und zur Freisetzung von vasokons triktiven Leukotrienen, freien Radikalen, Plättchenthromben und Proteasen. Es entsteht eine Stö rung der Mikrozirkulation und der Adhäsion von neutrophilen Granulozyten an das Endothel der kleinen Kapillaren.…”

Section: Pathomechanismusunclassified

“…Gerade bei älteren Patienten können Komplikationen ohne Warnsymptomatik auftreten. Die schwerwiegenden Komplikationen im unteren Gastrointes tinaltrakt sind Perforationen von Ulzera, verstärkte Blutungen und die Ausbildung von diaphragma tischen Stenosen vor allem im Colon ascendens [3,4,22]. In Fallberichten wird von einem longitu dinalen Ulkus über 20 cm Länge [23] oder auch tumorverdächtigen Ulzera [24] …”

Section: Dickdarmunclassified

Nichtsteroidale Antirheumatika und Gastrointestinaltrakt

Schick

Schulz

2010

Gastroenterologe

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Nichtsteroidale Antirheumatika (NSAR) wirken analgetisch, antipyretisch und antiphlogistisch. Weltweit werden sie vor allem zur Schmerzbekämpfung eingesetzt. Ihre Einnahme ist jedoch mit einer erheblichen Anzahl von Nebenwirkungen verbunden. Die Risiken von NSAR bestehen vor allem in Schleimhautläsionen, Dyspepsie, gastrointestinalen Blutungen, Ulzerationen, Perfora tionen und Stenosen. NSAR können in so genannte traditionelle NSAR, selektive NSAR (Zyklo oxygenasehemmer, COX1 und COX2Inhibitoren) und ASS unterteilt werden. Die Einführung von COX2Inhibitoren erfolgte zur Reduktion von Nebenwirkungen, jedoch zeigten große Studi en eine zu hohe Anzahl von kardiovaskulären Ereignissen, was zur Rücknahme einiger Präparate vom Markt führte. Läsionen im oberen Gastrointestinaltrakt infolge von NSAREinnahme sind lange bekannt. Mit der Einführung der Kapselendoskopie, der Ballonenteroskopie und der stärke ren Beachtung von Kolonläsionen zeigte sich ein ähnlich häufiges Auftreten von Nebenwirkungen im mittleren und unteren Gastrointestinaltrakt. In diesem Artikel werden die gastrointestinalen Ri siken vom Ösophagus bis zum Kolon erörtert und aktuelle Empfehlungen gegeben. SchlüsselwörterUlzera · Ösophagitis · Perforationsblutung · Magenausgangsstenose · Nichtsteroidale Antirheu matika Non-steroidal antiinflammatory drugs and gastrointestinal tract AbstractThe administration of nonsteroidal antiinflammatory drugs (NSAID) against pain is accepted worldwide, although it is well known that they cause potentially serious adverse effects. The risks from NSAIDs consist of mucosal lesions in the gastrointestinal (GI) tract, dyspepsia, gastrointes tinal bleeding, ulcera, perforation and stenosis. NSAIDs can be classified into traditional and se lective inhibitors of cyclooxygenase (COX1 and COX2 inhibitors) and aspirin. The discovery of COX2 inhibitors was celebrated as a new desired improvement for adverse events for a short time period, but large studies revealed a significant incidence of cardiovascular events in combination with COX2 inhibitors, which ended in a partial withdrawal of COX2 inhibitors from the mar ket. Adverse events were first only registered in the upper GI tract but with the introduction of bal loon enteroscopy and capsule endoscopy and the intensified view on detected lesions in the colon, a similar number of adverse events from NSAIDs could be registered in the lower GI tract. In this article gastrointestinal adverse events from the esophagus up to the colon will be discussed. Final ly an overview of the present recommendations is given.

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Strictures, diaphragms, erosions or ulcerations of ischemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drug-induced lesions

Cited by 22 publications

References 58 publications

NSAIDs-induced diaphragm-like colonic strictures: a case report

NSAIDs-induced diaphragm-like colonic strictures: a case report

Colonic mucosal lesions associated with long‐term or short‐term administration of nonsteroidal anti‐inflammatory drugs

Nichtsteroidale Antirheumatika und Gastrointestinaltrakt

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