title: [Underestimated adverse effects of non-steroidal anti-inflammatory drugs on the distal intestine].
abstract: NSAID-induced adverse effects are diagnosed less frequently in the distal intestine than in the gastroduodenal area. During long-term NSAID use, however, the development of life-threatening ulcerations, perforations or fibrotic stenoses must be expected from the middle segment of the small intestine to the rectum. Although the clinical symptoms are not specific, together with careful examination, endoscopy, contrast x-ray studies, or computed tomography they can provide orientation, at least with regard to stenotic processes. Diarrhea, weight loss, anorexia, irregular bowel movements, obstruction symptoms, ocoult blood loss, hypoalbuminemia, and iron deficiency may be regarded as possible signs of gastrointestinal adverse effects associated with long-term NSAID therapy. Except in the case of NSAID suppository abuse, no risk indicators are known. The pathogenesis of NSAID-induced adverse effects in the lower gastrointestinal tract has not been elucidated. As the potential of nonselective NSAIDs to cause adverse effects in distal segments of the small intestine cannot be reliably reduced by prophylactic measures in the upper gastrointestinal tract such as comedication with prostaglandin analogs or proton pump inhibitors, the indication for the use of conventional NSAIDs, in any case, must be considered with caution.
authors.affiliation: Rheumaklinik Wiesbaden, Klaus-Miehlke-Klinik, Leibnizstr. 23 65191 Wiesbaden. wolfgang.bolten@wiesbaden.netsurf.de
authors.forename: W W
authors.initials: WW
authors.lastname: Bolten
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D003106:Colon / Q000187:drug effects*; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000517:prevention & control; D012007:Rectum / Q000187:drug effects*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
vernacular_title: Unterschätzte NSA-Nebenwirkungen im distalen Intestinum.