Visible small-intestinal mucosal injury in chronic NSAID users.
OBJECTIVE
Patients who regularly take nonsteroidal anti-inflammatory drugs (NSAIDs) have an increased risk for small-intestinal mucosal ulceration and bleeding, which may present as anemia of undetermined gastrointestinal origin or protein loss. The prevalence and severity of small-intestinal lesions remains unclear. Our aim was to assess the frequency of NSAID-induced small-bowel injury among chronic NSAID users.


METHODS
Ambulatory patients with various types of arthritides who took NSAIDs daily (>3 mo duration) or took either acetaminophen alone or nothing were enrolled in the study. All patients fasted overnight and underwent wireless video capsule endoscopy. Two investigators, blind to therapy, reviewed each video beginning after the pylorus. Lesions were scored as normal, red spots, small erosions, large erosions, or ulcers. An ulcer was defined as a larger lesion with apparent depth and a definite rim.


RESULTS
Forty-one patients, 36 men and 5 women, ages ranging from 22 to 66 years (mean age, 49.8 y) were analyzed including 21 chronic NSAID users and 20 control patients. Small-bowel injury was seen in 71% of NSAID users compared with 10% of controls (P < .001). Injury was mild (few or no erosions, absence of large erosions/ulcers) in 10 NSAID users compared with 2 controls. Five NSAID users had major (>4 erosions or large ulcers/ulcers) damage compared with none in the control group. There were no complications or problems with the capsule endoscopy procedure.


CONCLUSIONS
Endoscopically evident small-intestinal mucosal injury is very common among chronic NSAID users. The role of endoscopically evident injury in unexplained iron-deficiency anemia and hypoalbuminemia among chronic NSAID users remains undetermined.
Graham
David Y
DY
Department of Medicine, VA Medical Center, Room 3A-320 (111D), 2002 Holcombe Boulevard, Houston, Texas 77030, USA. dgraham@bcm.tmc.edu
Opekun
Antone R
AR
Willingham
Field F
FF
Qureshi
Waqar A
WA
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001168:Arthritis / Q000188:drug therapy; D002214:Capsules; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000473:pathology; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D007421:Intestine, Small / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014456:Ulcer / Q000139:chemically induced* / Q000473:pathology; D014741:Video Recording
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002214:Capsules