title: Distribution of small intestinal mucosal injuries as a result of NSAID administration.
abstract: 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.
authors.affiliation: Nippon Medical School, Tokyo, Japan. s-fujimori@nms.ac.jp
authors.forename: Shunji
authors.initials: S
authors.lastname: Fujimori
authors.forename: Katya
authors.initials: K
authors.lastname: Gudis
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Tsuguhiko
authors.initials: T
authors.lastname: Seo
authors.forename: Yukie
authors.initials: Y
authors.lastname: Yamada
authors.forename: Akihito
authors.initials: A
authors.lastname: Ehara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Keigo
authors.initials: K
authors.lastname: Mitsui
authors.forename: Masaoki
authors.initials: M
authors.lastname: Yonezawa
authors.forename: Shu
authors.initials: S
authors.lastname: Tanaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tatsuguchi
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D004008:Diclofenac; D009853:Omeprazole