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NSAIDs: Adverse effects on the distal small bowel and colon

Louis-Michel Wong Kee Song, MD, FRCP(C)
Norman E Marcon, MD, FRCP(C)
Section Editor
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


The distal small bowel and colon are susceptible to the deleterious effects of nonsteroidal anti-inflammatory drugs (NSAIDs) [1-4]. The ileocecal region is a potential site for a variety of NSAID-induced injuries including erosions, ulcers, strictures, perforation, and the formation of diaphragms, which can lead to bowel obstruction [5-8]. NSAIDs can also lead to colitis resembling inflammatory bowel disease (IBD), exacerbate preexisting IBD, or complicate diverticular disease (ie, perforation or bleeding) [9,10]. Older adults and those on long-term NSAID therapy appear to be at highest risk [10]. There may also be an association between NSAID use and collagenous colitis. (See "Lymphocytic and collagenous colitis (microscopic colitis): Clinical manifestations, diagnosis, and management".)


A number of studies using different methodologies have evaluated the potential deleterious effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the small bowel and colon. Considered together, they suggest that NSAID-related intestinal injury is common. However, the proportion of patients who develop clinically important NSAID-induced enteropathy remains relatively small.

The following summarizes the range of findings:

Approximately two-thirds of NSAID users demonstrate intestinal inflammation by indirect methods of 111-Indium-labeled leukocyte scintigraphy and 111-Indium fecal excretion [11].

In a case-control study, patients with small or large bowel perforation or bleeding were more than twice as likely to be NSAID users [12].

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Literature review current through: Dec 2017. | This topic last updated: Nov 28, 2017.
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