Distribution of small intestinal mucosal injuries as a result of NSAID administration.
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) induce small intestinal mucosal injuries. The concentrations of NSAIDs, bile acids and intestinal flora may differ in the proximal and distal parts of the small intestine. This study aimed to analyse types and distributions of NSAID-induced small intestinal injuries.


METHODS
In total 55 healthy male volunteers were examined using baseline capsule endoscopy (CE). Subjects then undertook a 14-day regimen of NSAID medication (diclofenac sodium, 75 mg day(-1)) with proton-pump inhibitors (omeprazole 20 mg day(-1)) as gastroprotection. After 14 days, subjects underwent post-treatment CE and were assessed for three types of small intestinal injuries: denuded areas, erosions and ulcers. The proximal and distal parts of the small intestine were arbitrarily classified according to CE transit time from the duodenal bulb.


RESULTS
Baseline CE revealed six mucosal lesions in 6 of 55 subjects (11%), consisting of three denuded areas and three erosions. Post-treatment CE identified 636 lesions in 32 of 53 subjects (60%); including 115 denuded areas in 16 subjects, 498 erosions in 22 subjects and 23 ulcers in 8 subjects. The distribution of small intestinal injuries differed according to type; denuded areas (90%: 103/115) were predominantly located in the proximal part, erosions throughout the small intestine and all ulcers in the distal part. The location of ulcers and denuded areas differed statistically (P < 0.0001).


CONCLUSIONS
The impact of short-term NSAID medication on the small intestine differed according to intestinal site, with most denuded areas identified in the proximal part and all ulcers in the distal part.
Fujimori
Shunji
S
Nippon Medical School, Tokyo, Japan. s-fujimori@nms.ac.jp
Gudis
Katya
K
Takahashi
Yoko
Y
Seo
Tsuguhiko
T
Yamada
Yukie
Y
Ehara
Akihito
A
Kobayashi
Tsuyoshi
T
Mitsui
Keigo
K
Yonezawa
Masaoki
M
Tanaka
Shu
S
Tatsuguchi
Atsushi
A
Sakamoto
Choitsu
C
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D053704:Capsule Endoscopy; D004008:Diclofenac / Q000009:adverse effects*; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000473:pathology; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D007421:Intestine, Small / Q000187:drug effects* / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D014456:Ulcer / Q000139:chemically induced* / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D004008:Diclofenac; D009853:Omeprazole