title: Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy: endoscopic features of the lesions and endoscopic treatments for diaphragm disease.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) occasionally induce small-bowel injury. However, the clinical features have only been partially clarified. The aim of this study was to clarify the clinical features of the disease and evaluate the effectiveness of endoscopic balloon dilation therapy for diaphragm disease, using double-balloon endoscopy (DBE).
  
  
  METHODS
  This is a retrospective case study using our DBE database. Our inclusion criteria required patients to meet all the following criteria: (1) history of NSAID use; (2) endoscopic findings of erosion and/or ulcer and/or typical diaphragm-like strictures; (3) improvement in clinical findings (signs and symptoms) and/or endoscopic findings by cessation of NSAIDs, except for diaphragm disease; and (4) exclusion of other causes (e.g., malignant tumor, inflammatory bowel disease, and infectious disease). The clinical records of patients were investigated.
  
  
  RESULTS
  Eighteen patients were included. Sixteen patients showed ulcerative lesions, and the remaining 2 patients showed diaphragm diseases. For localized lesions, 12 patients evidenced lesions in the ileum, 5 patients had lesions in the duodenum and/or jejunum, and 1 had lesions in both intestines. The ulcerative lesions were multiple with various morphologies that were located unrelated to mesenteric or antimesenteric sides. The endoscopic balloon dilations were performed safely, and all patients improved with regard to their symptoms.
  
  
  CONCLUSIONS
  Symptomatic NSAID-induced small-bowel injuries exhibit a variety of patterns of ulcerative lesions as observed in the ileum in many cases. The endoscopic balloon dilation appears to be a safe and effective treatment for diaphragm disease.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taguchi
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Miyata
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Masayuki
authors.initials: M
authors.lastname: Arashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002404:Catheterization / Q000295:instrumentation; D016208:Databases, Factual; D004386:Duodenum / Q000187:drug effects / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000187:drug effects / Q000473:pathology; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D007583:Jejunum / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal