NSAIDs: Adverse effects on the distal small bowel and colon
- Louis-Michel Wong Kee Song, MD, FRCP(C)
Louis-Michel Wong Kee Song, MD, FRCP(C)
- Associate Professor of Medicine
- Mayo Clinic College of Medicine
- Norman E Marcon, MD, FRCP(C)
Norman E Marcon, MD, FRCP(C)
- Professor of Medicine
- University of Toronto
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 . There may also be an association between NSAID use and collagenous colitis. (See "Lymphocytic and collagenous colitis (microscopic colitis): Clinical manifestations, diagnosis, and management".)
STUDIES OF NSAID INJURY
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 .
●In a case-control study, patients with small or large bowel perforation or bleeding were more than twice as likely to be NSAID users .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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