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Effect of Nonsteroidal Anti-inflammatory Agents on Small Intestinal Injuries as Evaluated by Capsule Endoscopy

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Abstract

Background

Currently, because the population is aging, use of medications has been increasing, including use of nonsteroidal anti-inflammatory drugs (NSAIDs) and antithrombotic agents.

Aims

This study aims to investigate whether NSAIDs can cause damage to the small bowel (SB) mucosa.

Methods

Endoscopic videos of subjects who had undergone capsule endoscopy (CE) were evaluated by three experts in order to identify SB injury. All medications taken within 2 weeks from the time of CE were investigated. Cases with a final diagnosis of intestinal tuberculosis, inflammatory bowel disease, Behcet’s disease, Peutz–Jeghers syndrome, small bowel lymphoma, or Henoch–Schönlein purpura were excluded from the analysis.

Results

Among the 273 subjects, 125 (45.8%) had SB erosions or ulcers (erosion group) and the remaining 148 (54.2%) did not (no erosion group). SB erosions or ulcers were more common in females, patients aged > 60 years, and subjects taking NSAIDs (p = 0.048, 0.032, and < 0.001, respectively). No statistically significant differences were found between the two groups in the following variables: history of cancer and GI surgery, reasons for the test, comorbidities, and use of anticoagulants and antiplatelet agents. Multivariate analysis showed that use of NSAIDs [OR 4.191 (95% CI 1.858–9.458), p < 0.001] was an independent risk factor for SB erosions or ulcers.

Conclusions

Use of NSAIDs is the only independent risk factor for SB injury identified in this study. Antithrombotic agents do not cause or exacerbate damage to the SB, according to our results.

Clinical trial registration

KCT0004795.

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Abbreviations

CE:

Capsule endoscopy

NSAID:

Nonsteroidal anti-inflammatory drug

SB:

Small bowel

PPI:

Proton pump inhibitor

H2RA:

Histamine 2 receptor antagonist

GI:

Gastrointestinal

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 18450, Korea

    Sang Pyo Lee, Jin Lee, Sea Hyub Kae, Hyun Joo Jang & Eun Suk Jung

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  1. Sang Pyo Lee
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  2. Jin Lee
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  3. Sea Hyub Kae
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  4. Hyun Joo Jang
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  5. Eun Suk Jung
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Contributions

SPL contributed to study concept, design, analysis of data, and drafting of the manuscript; HJJ, ESJ, and SHK were involved in study concept and interpretation of the data; and JL contributed to critical revision of the manuscript and acquisition of the data.

Corresponding author

Correspondence to Sang Pyo Lee.

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Conflict of interest

The authors have no financial relationships relevant to this publication to disclose.

Ethics approval

The study protocol was approved by the Institutional Review Board (IRB) of Hallym University School of Medicine (HDT 2020-01-002-001).

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Lee, S.P., Lee, J., Kae, S.H. et al. Effect of Nonsteroidal Anti-inflammatory Agents on Small Intestinal Injuries as Evaluated by Capsule Endoscopy. Dig Dis Sci 66, 2724–2731 (2021). https://doi.org/10.1007/s10620-020-06511-z

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  • DOI: https://doi.org/10.1007/s10620-020-06511-z

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