title: Undisclosed use of nonsteroidal anti-inflammatory drugs may underlie small-bowel injury observed by capsule endoscopy.
abstract: OBJECTIVE
  Findings from capsule endoscopies (CEs) of patients with enteropathy from nonsteroidal anti-inflammatory drugs (NSAIDs) may be indistinguishable from those with Crohn's disease, making medication history crucial to image interpretation. Undeclared NSAID use has been proposed to cause unexplained peptic ulcers; we investigated whether it is also an issue among patients referred for small-bowel CE.
  
  
  METHODS
  We collected demographic data, indications for CE, and medication history prospectively. A salicylate spot test and gas chromatography-mass spectrometry were performed for NSAID metabolites in urine samples of patients undergoing routine CE. Videos were analyzed by a gastroenterologist who was blinded to the urinalysis results.
  
  
  RESULTS
  Seventy-six patients (52 women; mean age, 50 y) underwent CE for suspected small-bowel pathology. Urinalysis was positive in 13.6% of patients (salicylates, n = 3; ibuprofen, n = 6; and ibuprofen and diclofenac, n = 1) although only 1 of these patients declared use of an NSAID (aspirin). Although 2 patients had normal CE results, 80% had positive results, including the presence of erosions (n = 5), ulceration (n = 2), and ulcers with early stricturing (n = 1, diagnosed with Crohn's disease). A patient with small-bowel ulceration underwent surgery and was found to have NSAID-associated enteropathy, based on histologic analysis.
  
  
  CONCLUSIONS
  Of patients who undergo CE, 13.6% took NSAIDs or aspirin, but most did not declare using these medications. Small-bowel inflammation was common in this cohort and could be mistaken for Crohn's disease. Patients should be questioned about use of over-the-counter medications, and routine urinalysis for NSAID metabolites may be helpful before interpretation of CE findings.
authors.affiliation: Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Trust, Sheffield, United Kingdom.
authors.forename: Reena
authors.initials: R
authors.lastname: Sidhu
authors.forename: Lorraine K
authors.initials: LK
authors.lastname: Brunt
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Morley
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.forename: Mark E
authors.initials: ME
authors.lastname: McAlindon
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000032:analysis; D001241:Aspirin / Q000009:adverse effects / Q000032:analysis; D053704:Capsule Endoscopy / Q000379:methods*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014556:Urine / Q000737:chemistry
chemical_list: D000893:Anti-Inflammatory Agents; D001241:Aspirin