Clinical and endoscopic features of non-steroidal anti-inflammatory drug-induced colorectal ulcerations.
OBJECTIVE
Data on the clinical and endoscopic features of non-steroidal anti-inflammatory drug (NSAID)-induced colorectal ulcerations are very limited from Taiwan. We analyzed the clinical manifestations, endoscopic and histologic findings, and outcomes of patients with NSAID-induced colorectal ulcerations in Southern Taiwan.


METHODS
From January 1997 to December 2001, 4200 patients underwent total colonoscopy at a tertiary referral center in Southern Taiwan. We retrospectively analyzed the medical records and endoscopic files. The diagnosis of NSAID colorectal ulceration required the following clinical, histologic and colonoscopic findings: patients presenting with gastrointestinal complaints were taking NSAIDs; presence of colorectal ulcerations confirmed by colonoscopy; no evidence of neoplasm or of specific inflammation in biopsy specimens obtained from the margins of ulcers; no evidence of pathogenic microorganism in cultures of biopsy specimens and stools; no prior history of chronic inflammatory bowel diseases; improvement of ulcers, as confirmed by endoscopy, and improvement of presenting symptoms after the discontinuation of NSAID therapy.


RESULTS
NSAID-induced colorectal ulcerations were diagnosed in 19 (0.45%) of the 4200 patients, including 10 females and 9 males with a mean age of 64.7+/-15.4 years. Of the 19 patients, 13 presented with acute onset of painless rectal bleeding, 4 with nonspecific abdominal distress, and 2 with iron deficiency anemia, weight loss and lower abdominal pain. Colonoscopy revealed ulcerations in the ileocecal region in 11 patients, lesions in the distal rectum in 6, and colonic strictures with circumferential ulcerations on the central rim located in the ileocecal region in 2. Eight patients had comorbidity including renal failure (4), uncomplicated liver cirrhosis (2), and previous cerebrovascular accidents (2). Diclofenac and piroxicam were the most commonly involved drugs. Patients with acute onset rectal bleeding were also being treated with concomitant booster intravenous dose of NSAIDs before the bleeding episode. Most of the patients recovered uneventfully with the discontinuation of NSAID therapy.


CONCLUSIONS
NSAID-induced colorectal ulceration is a clinically significant disease which may be under-recognized. Lower gastrointestinal tract evaluation should be considered in patients who are using NSAIDs and who have acute rectal bleeding, anemia and lower gastrointestinal complaints.
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Yong-Sang
YS
Pan
Li-Tzong
LT
Chen
Chang-An
CA
Tseng
Yu-Chung
YC
Su
Chang-Ming
CM
Jan
Wen-Ming
WM
Wang
Kun-Bow
KB
Tsai
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003108:Colonic Diseases / Q000139:chemically induced* / Q000628:therapy; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000628:therapy; D012002:Rectal Diseases / Q000139:chemically induced* / Q000628:therapy; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal