NSAID injury to the small intestine.
OBJECTIVE
To identify the clinical and radiologic findings in patients with diaphragm-like strictures in the small bowel.


METHODS
We reviewed the histories, radiologic findings, and pathologic findings in two men and two women, all in their sixties, with a history of long-term nonsteroidal antiinflammatory drug (NSAID) or aspirin (ASA) usage and one or more radiologically demonstrated diaphragm-like strictures in the small bowel.


RESULTS
Two patients had long histories of NSAID usage, and two of ASA usage. One NSAID user had a long segment of jejunal involvement, and the other three had short segments of duodenal involvement. The ASA users presented with symptoms of esophageal disease, the small bowel lesions were unexpected, and ASA usage was not initially elicited. In one NSAID user and one ASA user, broader strictures with humps rather than diaphragms were also seen producing a lifesaver-like or bagel-like configuration.


CONCLUSIONS
Multiple diaphragm-like strictures can occur in NSAID injury and are pathognomonic except in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID injury and peptic ulceration. ASA should be considered an NSAID with regard to small-bowel toxicity. A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, and a dedicated small bowel examination is required when NSAID injury is suspected.
Zalev
A H
AH
Department of Radiology, University of Toronto and St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Gardiner
G W
GW
Warren
R E
RE
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002446:Celiac Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D004412:Dysmenorrhea / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000188:drug therapy; D006801:Humans; D007415:Intestinal Obstruction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin