Chronic NSAID Use: Small

Bowel Injury
ALEXANDAR
 NSAIDs and the Small Intestine
The occasional finding of intestinal blood loss
or anemia in the setting of normal upper and
lower endoscopy led to the realization that:
• NSAID-induced small intestinal ulceration
and bleeding were clinically important

Hedenbro JL, et al. Gastrointest Endosc 1988;34:247-251

Upadhyay R, et al. Ann Rheum Dis 1990;49:359-362
 A Controlled Study of NSAID-induced
Small Bowel Injury Using VCE
Methods:
• 41 ambulatory subjects (mean age = 49.5
y) with various types of arthritides
(OA/RA/gout/non-specific) were
enrolled
• 21 subjects took NSAIDs daily (>3 mo
duration)
• 20 took acetaminophen alone or nothing.
 The Pill Camera

1.
1. Optical
Optical dome
dome
2.
2. Lens
Lens holder
holder
3.
3. Lens
Lens
4.
4. Illuminating
Illuminating LEDs
LEDs (light
(light
emitting
emitting diodes)
diodes)
5.
5. CMOS
CMOS image
image sensor
sensor
6.
6. Battery
Battery
7.
7. ASIC
ASIC (Application
(Application Specific
Specific
Integrated
Integrated Circuit)
Circuit) transmitter
transmitter
Dimensions:
8.
8. Antenna
Antenna Height: 11mm
Length: 26mm
Weight: 3.7gm
Small Bowel Ulcer
NSAID Ulceration
Blood in Terminal Ileum
 A Controlled Study of NSAID-induced
Small Bowel Injury Using VCE
Results:
NSAID users Controls
Any injury 71% 10%
Severe injury 20% 0%

any injury (p<0.001)

• Severe damage was associated with high dose

indomethacin, naproxen, and ibuprofen use.
 Conclusions
Symptoms and signs of ill-health among chronic
NSAID users are often attributed to the underlying
disease
Possible evidence of NSAID enteropathy includes:
• Dyspepsia that does not respond to PPI
• Vague abdominal pain that eludes diagnosis or
treatment
• Iron deficiency anemia
• Hypoalbuminemia
 NSAID-induced Small Bowel Injury
Conclusions
• VCE is a useful tool for diagnosing
NSAID-induced small intestinal mucosal
injury
• VCE should be considered in patients on
NSAIDs with unexplained symptoms
• Prospective comparisons of NSAIDs or
other drugs and the GI tract
THE END