title: [Ulcers of the colon in association with nonsteroidal anti-inflammatory drugs (NSAID)--a rare cause of gastrointestinal bleeding? Report of 3 cases].
abstract: Although adverse side effects of nonsteroidal anti-inflammatory drugs (NSAID) can affect the whole gastrointestinal tract, most reports refer to upper gastrointestinal tract complications. We report on 3 patients with lower gastrointestinal bleeding (patient 1 and 2) respectively detectable fecal blood loss (patient 3) after the use of NSAID. Patient 1 and 3 were taking NSAID over at least 6 months for the treatment of rheumatic diseases while patient 2 reported a single use of 2 g acetylsalicylic acid. Colonoscopy showed a single ulcer of the colon in patients 1 and 2. Due to acute bleeding patient 1 required interventional endoscopic treatment. Colonoscopy of patient 3 revealed multiple colonic ulcerations. Gastroduodenoscopy also detected adverse NSAID-effects on the upper gastrointestinal tract in patient 1 and 3 (ulcers of the stomach, erosive duodenitis). NSAID-medication was discontinued in all patients and, additionally, mesalazine was administered to patient 3. Consecutively, symptoms and lesions disappeared. Our cases stress the clinical importance of NSAID-toxicity distal to the small intestine which may exist concomitantly to lesions of the upper gastrointestinal tract and is not obligatory dose-dependent.
authors.affiliation: Medizinische Klinik IV (Gastroenterologie und Hepatologie), Universitätsklinikum Heidelberg. Lukas_Schwake@med.uni-heidelerg.de
authors.forename: L
authors.initials: L
authors.lastname: Schwake
authors.forename: T
authors.initials: T
authors.lastname: Schlenker
authors.forename: S
authors.initials: S
authors.lastname: Schwake
authors.forename: W J
authors.initials: WJ
authors.lastname: Hofmann
authors.forename: W
authors.initials: W
authors.lastname: Stremmel
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003093:Colitis, Ulcerative / Q000139:chemically induced* / Q000175:diagnosis; D003113:Colonoscopy; D003937:Diagnosis, Differential; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006261:Headache / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
vernacular_title: Kolonulzera nach der Einnahme nichtsteroidaler Antiphlogistika--eine seltene Ursache gastrointestinaler Blutungen? Bericht von 3 Fällen.