Date: 16 Jan 2009
Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy: endoscopic features of the lesions and endoscopic treatments for diaphragm disease
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Nonsteroidal anti-inflammatory drugs (NSAIDs) occasionally induce small-bowel injury. However, the clinical features have only been partially clarified. The aim of this study was to clarify the clinical features of the disease and evaluate the effectiveness of endoscopic balloon dilation therapy for diaphragm disease, using double-balloon endoscopy (DBE).
This is a retrospective case study using our DBE database. Our inclusion criteria required patients to meet all the following criteria: (1) history of NSAID use; (2) endoscopic findings of erosion and/or ulcer and/or typical diaphragm-like strictures; (3) improvement in clinical findings (signs and symptoms) and/or endoscopic findings by cessation of NSAIDs, except for diaphragm disease; and (4) exclusion of other causes (e.g., malignant tumor, inflammatory bowel disease, and infectious disease). The clinical records of patients were investigated.
Eighteen patients were included. Sixteen patients showed ulcerative lesions, and the remaining 2 patients showed diaphragm diseases. For localized lesions, 12 patients evidenced lesions in the ileum, 5 patients had lesions in the duodenum and/or jejunum, and 1 had lesions in both intestines. The ulcerative lesions were multiple with various morphologies that were located unrelated to mesenteric or antimesenteric sides. The endoscopic balloon dilations were performed safely, and all patients improved with regard to their symptoms.
Symptomatic NSAID-induced small-bowel injuries exhibit a variety of patterns of ulcerative lesions as observed in the ileum in many cases. The endoscopic balloon dilation appears to be a safe and effective treatment for diaphragm disease.
Bjarnason I, Price AB, Zanelli G, Smethurst P, Burke M, Gumpel JM, et al. Clinicopathological features of nonsteroidal anti-inflammatory drug-induced small intestinal strictures. Gastroenterology 1988;94:1070–1074.PubMed
Allison MC, Howatson AG, Torrance CJ, Lee FD, Russell RI. Gastrointestinal damage associated with the use of nonsteroidal anti-inflammatory drugs. N Engl J Med 1992;327:749–754.PubMed
Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature (Lond) 2000;405:417.CrossRef
Kamata Y, Iwamoto M, Nara H, Kamimura T, Takayashiki N, Yamamoto H, et al. A case of rheumatoid arthritis with protein losing enteropathy induced by multiple diaphragmatic strictures of the small intestine: successful treatment by bougieing under double-balloon enteroscopy. Gut 2006;55:1372.PubMedCrossRef
Matsuhashi N, Yamada A, Hiraishi M, Konishi T, Minota S, Saito T, et al. Multiple strictures of the small intestine after long-term nonsteroidal anti-inflammatory drug therapy. Am J Gastroenterol 1992;87:1183–1186.PubMed
Kessler WF, Shires GT III, Fahey TJ III. Surgical complications of nonsteroidal anti-inflammatory drug-induced small bowel ulceration. J Am Coll Surg 1997;185:250–254.PubMed
Hayashi Y, Yamamoto H, Kita H, Sunada K, Sato H, Yano T, et al. Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy. World J Gastroenterol 2005;11:4861–4864.PubMed
Gorbach SL, Plaut AG, Nahas L, Weinstein L, Spanknebel G, Levitan R. Studies of intestinal microflora. II. Microorganisms of the small intestine and their relations to oral and fecal flora. Gastroenterology 1967;53:856–867.PubMed
- Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy: endoscopic features of the lesions and endoscopic treatments for diaphragm disease
Journal of Gastroenterology
Volume 44, Issue 19 Supplement, pp 57-63
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- double-balloon endoscopy
- small-bowel injury
- diaphragm disease
- endoscopic balloon dilation
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan