Macroscopic small bowel mucosal injury caused by chronic nonsteroidal anti-inflammatory drugs (NSAID) use as assessed by capsule endoscopy.
OBJECTIVE
To evaluate the type, frequency, and severity of macroscopic small bowel mucosal injury after chronic NSAID intake as assessed by capsule endoscopy (CE), as well as to correlate the severity of gastroduodenal and intestinal damage in these patients.


METHODS
A prospective, endoscopist-blind, controlled trial. Sixteen patients (14F/2M; age: 57.06 +/- 10.16 yrs) with osteoarthritis (OA) on chronic therapy with NSAIDs underwent CE and upper gastrointestinal endoscopy (UGE). Seventeen patients with OA (9F/2M; age: 57.47 +/- 9.82 yrs) who did not take NSAIDs were included as a control group. A scale ranging from 0 to 2 (0 = no lesions, 1-minor = red spots or petechiae, denuded areas and/or 1-5 mucosal breaks; 2-major = > 5 mucosal breaks and/or strictures, or hemorrhage) was designed to assess the severity of small bowel mucosal injuries.


RESULTS
CE found intestinal lesions in 75% (12/16) of patients in the study group and in 11.76% (2/17) of controls (p < 0.01). Seven out of 16 NSAID consumers (43.75%) and none in the control group (0%) had a major small bowel mucosal injury (p < 0.01). The percentages of patients with grade 1 and 2 gastroduodenopathy in the study group, as assessed by UGE, were 37.14 and 23.81%, respectively. There was no significant difference in the rate of major enteropathy between patients with none or minor gastroduodenal injury, and those with major gastroduodenopathy (43.75 vs. 40%; p = N.S.).


CONCLUSIONS
Chronic NSAID intake is associated with a high rate of small bowel mucosal injuries. Our data have failed to demonstrate a relationship between the severity of gastroduodenal and intestinal injury.
Caunedo-Alvarez
A
A
Service of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain. acaunedoa@meditex.es
Gómez-Rodríguez
B J
BJ
Romero-Vázquez
J
J
Argüelles-Arias
F
F
Romero-Castro
R
R
García-Montes
J M
JM
Pellicer-Bautista
F J
FJ
Herrerías-Gutiérrez
J M
JM
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D053704:Capsule Endoscopy; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D004008:Diclofenac / Q000009:adverse effects / Q000627:therapeutic use; D004378:Duodenal Diseases / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D004381:Duodenal Ulcer / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013272:Stomach Diseases / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D013276:Stomach Ulcer / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D004008:Diclofenac; C539402:dexibuprofen; D007052:Ibuprofen