title: Strictures, diaphragms, erosions or ulcerations of ischemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drug-induced lesions.
abstract: OBJECTIVE
  To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA-induced erosions and ulcers of the stomach.
  
  
  METHODS
  In the period between 1997 and 2002, we investigated biopsy materials obtained from 611 patients (415 women, 196 men, average age 60.5 years) with endoscopic focal erosions, ulcerations, strictures or diaphragms in the colon. In the biopsies obtained from these lesions, we always established the suspected diagnosis of NSAID-induced lesions whenever necroses of the ischemic type were found. Together with the histological report, we enclosed a questionnaire to investigate the use of medication. The data provided by the questionnaire were then correlated with the endoscopic findings, the location, number and nature of the lesions, and the histological findings.
  
  
  RESULTS
  At the time of their colonoscopy, 86.1% of the patients had indeed been taking NSAID/ASA medication for years (43.9%) or months (29.5%). The most common indication for the use of these drugs was pain (64.3%), and the most common indication for colonoscopy was bleeding (55.5%). Endoscopic inspection revealed multiple erosions and/or ulcers in 60.6%, strictures in 15.8%, and diaphragms in 3.0% of the patients. The lesions were located mainly in the right colon including the transverse colon (79.9%). A separate analysis of age and sex distribution, endoscopic and histological findings for NSAIDs alone, ASA alone, combined NSAID/ASA, and for patients denying the use of such drugs, revealed no significant differences among the groups.
  
  
  CONCLUSIONS
  This uncontrolled retrospective study based on the histological finding of an ischemic necrosis shows that the histologically suspected diagnosis of NSAID-induced lesions in the colon is often correct. The true diagnostic validity of this finding and the differentiation from ischemic colitis should, however, be investigated in a prospective controlled study.
authors.affiliation: Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, Bayreuth 95445, Germany. pathologie.klinikum-bayreuth@t-online.de
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Diana
authors.initials: D
authors.lastname: Karimi
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Hildegard
authors.initials: H
authors.lastname: Volkholz
authors.forename: Klaus
authors.initials: K
authors.lastname: Dirschmid
authors.forename: Sigrid
authors.initials: S
authors.lastname: Rappel
authors.forename: Birgit
authors.initials: B
authors.lastname: Bethke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003106:Colon / Q000187:drug effects / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000473:pathology; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal