Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 Aug 21;11(31):4861-4.
doi: 10.3748/wjg.v11.i31.4861.

Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

Yoshikazu Hayashi  1 , Hironori Yamamoto, Hiroto Kita, Keijiro Sunada, Hiroyuki Sato, Tomonori Yano, Michiko Iwamoto, Yutaka Sekine, Tomohiko Miyata, Akiko Kuno, Takaaki Iwaki, Yoshiyuki Kawamura, Hironari Ajibe, Kenichi Ido, Kentaro Sugano
Affiliations

Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

Yoshikazu Hayashi et al. World J Gastroenterol. .

Abstract

Aim: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy.

Methods: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone double-balloon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient.

Results: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively. The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug.

Conclusion: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Endoscopic view of the punched-out ulcer in the ileum in a 65-year-old woman (patient 3). Edematous villi were observed around the ulcer.
Figure 2
Figure 2
Endoscopic view of the ulcer with oozing hemorrhage in the ileum in a 74-year-old woman (patient 4). A: Before coagulation therapy; B: After coagulation therapy.
Figure 3
Figure 3
Endoscopic view of the (A) circular ulcer and (B) circular ulcer scar in the ileum in a 67-year-old woman (patient 7).
See this image and copyright information in PMC

References

    1. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology. 1993;104:1832–1847. - PubMed
    1. Davies NM, Saleh JY, Skjodt NM. Detection and prevention of NSAID-induced enteropathy. J Pharm Pharm Sci. 2000;3:137–155. - PubMed
    1. de Sanctis S, Qureshi T, Stebbing JF. Clinical and pathological overlap in nonsteroidal anti-inflammatory drug-related small bowel diaphragm disease and the neuromuscular and vascular hamartoma of the small bowel. Am J Surg Pathol. 2001;25:539–541. - PubMed
    1. Allison MC, Howatson AG, Torrance CJ, Lee FD, Russell RI. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med. 1992;327:749–754. - PubMed
    1. Madhok R, MacKenzie JA, Lee FD, Bruckner FE, Terry TR, Sturrock RD. Small bowel ulceration in patients receiving non-steroidal anti-inflammatory drugs for rheumatoid arthritis. Q J Med. 1986;58:53–58. - PubMed

Substances