title: Adverse effects of nonsteroidal anti-inflammatory drugs on the colon.
abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and a growing body of evidence suggests that they have adverse effects in the lower gastrointestinal (GI) tract in addition to the well-described toxicity in the upper GI tract. Among NSAID users who develop adverse GI effects, the proportion with lower GI events is as high as 40%. Most of the available evidence is taken from case-control studies and case reports; no large, randomized, placebo-controlled study has specifically set out to determine the magnitude of NSAID toxicity on the colon. However, the data suggest that NSAIDs cause a primary macroscopic colitis, collagenous colitis, an increased risk of complicated diverticular disease, and exacerbations of preexisting inflammatory bowel disease. Treatment depends on withdrawal of the causative drug.
authors.affiliation: Queen Elizabeth the Queen Mother Hospital, St Peter's Road, Margate CT9, UK. anne.ballinger@ekht.nhs.uk
authors.forename: Anne
authors.initials: A
authors.lastname: Ballinger
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003092:Colitis / Q000139:chemically induced; D003106:Colon / Q000187:drug effects*; D003108:Colonic Diseases / Q000139:chemically induced*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
references.citation: Digestion. 1988;41(2):116-20
references.pmid: 3265394
references.citation: Gastroenterology. 1992 Sep;103(3):862-9
references.pmid: 1499936
references.citation: Gut. 1995 Oct;37(4):509-11
references.pmid: 7489937
references.citation: Arch Intern Med. 2000 Oct 23;160(19):2947-54
references.pmid: 11041902
references.citation: Br J Surg. 1990 Oct;77(10):1103-4
references.pmid: 2121310
references.citation: Dig Dis Sci. 2007 Dec;52(12):3321-8
references.pmid: 17410449
references.citation: Br J Surg. 2003 Oct;90(10):1267-72
references.pmid: 14515298
references.citation: Am J Gastroenterol. 2007 Feb;102(2):324-30
references.pmid: 17100977
references.citation: Am J Gastroenterol. 2003 Aug;98(8):1834-7
references.pmid: 12907340
references.citation: Can J Gastroenterol. 2002 Dec;16(12):861-2
references.pmid: 12522475
references.citation: Am J Gastroenterol. 2005 Aug;100(8):1694-5
references.pmid: 16144121
references.citation: Aliment Pharmacol Ther. 2004 Nov 15;20(10):1035-43
references.pmid: 15569105
references.citation: Arch Intern Med. 1998 Jan 12;158(1):33-9
references.pmid: 9437376
references.citation: Hepatogastroenterology. 2002 Mar-Apr;49(44):345-8
references.pmid: 11995447
references.citation: Ann Intern Med. 1995 Aug 15;123(4):241-9
references.pmid: 7611589
references.citation: Am J Clin Pathol. 1998 Nov;110(5):622-8
references.pmid: 9802347
references.citation: Ann R Coll Surg Engl. 2002 Mar;84(2):93-6
references.pmid: 11995772
references.citation: Prev Med. 2002 Apr;34(4):455-62
references.pmid: 11914052
references.citation: J Clin Gastroenterol. 1993 Jan;16(1):31-4
references.pmid: 8421141
references.citation: Dis Colon Rectum. 2000 May;43(5):685-91
references.pmid: 10826432
references.citation: Dig Dis Sci. 1993 Sep;38(9):1619-23
references.pmid: 8359073
references.citation: Dig Liver Dis. 2005 May;37(5):372-6
references.pmid: 15843089
references.citation: Aliment Pharmacol Ther. 1997 Apr;11(2):283-91
references.pmid: 9146764
references.citation: Ann Pharmacother. 1998 Apr;32(4):485-94
references.pmid: 9562147
references.citation: Dig Dis Sci. 1997 May;42(5):990-7
references.pmid: 9149053
references.citation: BMJ. 1997 Nov 22;315(7119):1333-7
references.pmid: 9402773
references.citation: Br J Surg. 1991 Feb;78(2):190-1
references.pmid: 2015469
references.citation: BMJ. 1996 Jun 22;312(7046):1563-6
references.pmid: 8664664
references.citation: Gastroenterology. 2003 Feb;124(2):288-92
references.pmid: 12557133
references.citation: Br Med J (Clin Res Ed). 1985 Feb 2;290(6465):347-9
references.pmid: 3917814
references.citation: Arch Intern Med. 1992 Mar;152(3):625-32
references.pmid: 1546927
references.citation: Gastroenterology. 1997 Mar;112(3):683-9
references.pmid: 9041228
references.citation: Gastroenterol Clin Biol. 2005 Dec;29(12):1294-5
references.pmid: 16518292
references.citation: Dis Colon Rectum. 2008 Jan;51(1):116-20
references.pmid: 18085336
references.citation: Aliment Pharmacol Ther. 2003 Mar 15;17(6):817-25
references.pmid: 12641504
references.citation: Clin Gastroenterol Hepatol. 2006 Feb;4(2):203-11
references.pmid: 16469681
references.citation: Ann Rheum Dis. 2004 May;63(5):588-90
references.pmid: 15082493
references.citation: Clin Gastroenterol Hepatol. 2006 Feb;4(2):196-202
references.pmid: 16469680
references.citation: Presse Med. 2005 Mar 26;34(6):443-5
references.pmid: 15902876
references.citation: Agents Actions. 1984 Jun;14(5-6):715-8
references.pmid: 6591772
references.citation: Gastroenterology. 2002 Nov;123(5):1527-42
references.pmid: 12404228