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. 2016:2016:3679741.
doi: 10.1155/2016/3679741. Epub 2016 Mar 28.

Clinical Features, Diagnosis, and Treatment Strategies of Gastrointestinal Diaphragm Disease Associated with Nonsteroidal Anti-Inflammatory Drugs

Yan-Zhi Wang  1 , Gang Sun  1 , Feng-Chun Cai  1 , Yun-Sheng Yang  1
Affiliations

Clinical Features, Diagnosis, and Treatment Strategies of Gastrointestinal Diaphragm Disease Associated with Nonsteroidal Anti-Inflammatory Drugs

Yan-Zhi Wang et al. Gastroenterol Res Pract. 2016.

Abstract

Background. To demonstrate the clinical features, diagnosis, and treatment of nonsteroidal anti-inflammatory drug- (NSAID-) induced diaphragm disease (DD). Methods. A literature search between January 1973 and August 2015 was undertaken. The clinical data of patients with NSAID-induced DD were recorded and analyzed. Results. 159 patients were included. The ratio of male to female was 1 : 2.3; the mean age was 65 ± 11 years. The most common clinical manifestations were gastrointestinal bleeding and obstruction. 121 (84%) patients took traditional NSAIDs. The durations of NSAIDs use ranged from 2 to 300 months. A majority (59.7%) of DD were seen in the small bowel, were seen secondly in the colon (30.2%), and were mainly located in the ileum (57.9%) and right colon (91.7%), respectively. 80% of patients had multiple diaphragms. 41.5% of small bowel DD were diagnosed preoperatively by capsule endoscopy and/or double-balloon enteroscopy, 52.1% at laparotomy. Nearly 75% of patients underwent surgery, endoscopic balloon dilation was performed in 22 patients, and NSAIDs were withdrawn in 53 patients. Conclusions. NSAID-induced DD is relatively rare. The small bowel is most commonly involved. Preoperative diagnosis of small bowel DD is relatively difficult. Discontinuation of the NSAIDs is recommended, surgical resection is the main treatment presently, and endoscopic balloon dilation should be considered as an alternative therapy.

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Figures

Figure 1
Figure 1
Literature search and management procedure.
Figure 2
Figure 2
Location of diaphragm-like stricture. Postoperative ileum proximal to the ileal-sigmoid anastomosis (one case) and bypassed ileal segment (one case). Left colon and other included descending colon (one case), lower sigmoid (one case), rectosigmoid junction (one case), and ileocaecal valve, ascending colon, transverse colon, and descending colon were all involved in one case. Other locations included jejunum and duodenum (3 cases); jejunum, duodenum, and pylorus (one case); terminal ileum, ileocaecal valve, caecum, and ascending colon (one case); terminal ileum and ascending colon (one case); terminal ileum and ileocaecal junction (one case); terminal ileum and ileocaecal valve (one case).
Figure 3
Figure 3
Diagnostic methods. Other methods included autopsy (one case), small bowel enema (one case), and sigmoidoscopy (one case).
Figure 4
Figure 4
Treatment for patients with NSAIDs-induced DD.
See this image and copyright information in PMC

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