Over 100 million prescriptions for NSAIDs are written each year.
However, patients who regularly take NSAIDs have an increased risk of small intestinal mucosal ulceration and bleeding. This may present as anemia of undetermined GI origin, or protein loss.
At this time, the prevalence and severity of small intestinal lesions remains unclear. Although, a previous autopsy study found nonspecific small ulcerations in 8% of NSAID users, compared with 0.6% of nonusers.
In this study, researchers from Houston, Texas, assessed the utility of the Given Video Endoscopic Capsule (VCE) System in detecting NSAID-induced small intestinal injury.
Dr David Graham's team enrolled 41 ambulatory patients with various types of arthritides in the study. The patients' mean age was 49.5 years.
Of the 40 participants, 21 took NSAIDs daily, for more than 3 months duration, and 20 controls took acetaminophen alone or nothing. The research team excluded subjects who took low dose ASA.
All patients fasted overnight and underwent VCE.
|The team identified severe injury in 33% of NSAID users.|
|American Gastroenterological Association|
The pylorus was marked on each video. Then 2 investigators who were blinded to the subjects' therapy reviewed each video, beginning after the pylorus.
The team used definite erosions as the critical variable to predict population subsets.
The researchers found the VCE detected erosions in 42% of NSAID users, compared to 5% in non-NSAID users.
Furthermore, the team identified severe injury in 33% of NSAID users, compared with 0% of non-users.
They found that the typical lesion in subjects with severe damage was a lesion resembling a coral polyp. This is known as a coral polyp ulcer, or erosion, depending on size.
Dr Graham's team determined that severe damage was associated with high dose indomethacin, naproxen, and ibuprofen use.
They also found that small intestinal mucosal injury with diffuse erosions/ulcerations was approximately 4-fold more common than predicted in the autopsy study.
The researchers concluded that NSAID small bowel injury is common.
However, it is now possible to develop grading scales, and to investigate clinical correlations of endoscopic small intestinal damage.