A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy.
OBJECTIVE
Conventional acidic nonsteroidal anti-inflammatory drugs frequently cause small bowel inflammation. Diagnosis is largely based on assay of surrogate markers of inflammation in stool, such as fecal calprotectin. However, stool markers are not widely available and the precise nature of this inflammation is uncertain. We used wireless capsule enteroscopy to quantitate and assess the nature of the small bowel damage caused by nonsteroidal anti-inflammatory drugs when taken on a short-term basis.


METHODS
Forty healthy volunteers underwent a baseline capsule enteroscopy and fecal calprotectin test. After taking diclofenac slow-release 75 mg twice a day (with omeprazole 20 mg twice a day for gastroprotection) for a total of 14 days, both investigations were repeated.


RESULTS
After drug treatment, 30 subjects (75%) had increased repeat fecal calprotectin concentrations above the upper limit of normal. Capsule enteroscopy showed new pathology in 27 subjects (68%). The commonest lesions were mucosal breaks, seen in 16 (40%), which were seen to be bleeding in 2 (5%); reddened folds in 14 (35%); petechiae or red spots in 13 (33%); denuded mucosa in 8 (20%); and blood in the lumen without a visualized source in 3 (8%). Fifteen of the 27 subjects had more than one lesion concurrently.


CONCLUSIONS
This study provides both biochemical and direct evidence of macroscopic injury to the small intestine in 68%-75% of volunteers resulting from 2 weeks' ingestion of slow-release diclofenac.
Maiden
Laurence
L
Department of Medicine, Guy's, King's, St Thomas' Medical School, London, England. lpmaiden@doctors.net.uk
Thjodleifsson
Bjarni
B
Theodors
Asgeir
A
Gonzalez
Juan
J
Bjarnason
Ingvar
I
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D003692:Delayed-Action Preparations; D004008:Diclofenac / Q000009:adverse effects*; D020776:Endoscopes, Gastrointestinal; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D003692:Delayed-Action Preparations; D039841:Leukocyte L1 Antigen Complex; D004008:Diclofenac; D009853:Omeprazole