Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for treatment of arthritis and many other painful conditions. These drugs may cause damage not only to the upper gastrointestinal tract but also to the small and large intestine. This prospective study aimed to determine the presence of colonic lesions among 24 patients who were receiving NSAIDs for more than 3 months, and presented with diarrhea, intractable abdominal pain, and lower GI bleeding. Colonoscopy was done and multiple biopsies from different sites in the colon were obtained. Colonoscopy was normal in 11 (45.8%), showed inflammation or superficial ulcers in 7 (29.1%) and solitary or multiple deep ulcers in 6 (25%). Histology showed erosions in 12 (50%) and lymphocytic colitis in 9 (37.5%); histology was normal in 4 (16.6%). NSAID-induced colonic damage may have clinically significant sequel.
Similar content being viewed by others
References
Fries JF, Williams CA, Bloch DA. The relative toxicity of nonsteroidal anti-inflammatory drugs. Arthritis Rheum 1991;34:1353–1357.
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.
Aabakken L. Non-steroidal, anti-inflammatory drugs-the extending scope of gastrointestinal side effects. Aliment Pharmacol Ther 1992;6:143–162.
Chatelain D, Mokrani N, Flejou JF. Microscopic colitis: Collagenous colitis and lymphocytic colitis. Ann Pathol 2007;27:448–458.
Katsinelos P, Christodoulo K, Pilpilidis I, et al. Colopathy associated with the systemic use of nonsteroidal anti-inflammatory medications. An underestimated entity. Hepatogastroenterology 2002;49:345–348.
Larkai EN, Smith JL, Lidsky MD, Graham DY. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patents during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 1987;82:1153–1158.
Bjarnason I, Hayllar J, Macpherson AJ, Russell AS. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology 1993;104:1832–1847.
Hoftiezer JW, Silvoso GR, Burks M, Ivy KJ. Comparison of the effect of regular and enteric-coated aspirin on gastroduodenal mucosa of man. Lancet 1980;2:609–612.
Trondstad RI, Aadland E, Holler T, Olassen B. Gastroscopic findings after treatment with enteric-coated and plain naproxen tablets in healthy subjects. Scand J Gastroenterol 1985;20:239–242.
Byrne MF, McGuinness J, Smyth CM, et al. Nonsteroidal anti-inflammatory drug-induced diaphragms and ulceration in the colon. Eur J Gastroenterol Hepatol 2002;14:1265–1269.
Puspok A, Kiener HP, Oberhuber H. Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. Dis Colon Rectum 2000;43:658–691.
Collins AJ, Davies J, Dixon AS. A prospective endoscopic study of the effect of Orudis and Oruvail on the upper gastrointestinal tract in patients with osteoarthritis. Brit J Rheumatol 1988;27:106–109.
Bakshi R, Ezzet N, Frey L. Efficacy and tolerability of diclofenac dispersible in patents with osteoarthrosis. Curr Ther Res 1992;52:307–316.
Parfitt JR, Driman DK. Pathological effects of drugs on the gastrointestinal tract: a review. Human Pathol 2007;38:527–536.
Goldstein NS, Bhanot P. Paucicellular and asymptomatic lymphocytic colitis: expanding the clinicopathologic spectrum of lymphocytic colitis. Am J Clin Pathol 2004;122:405–411.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Geramizadeh, B., Taghavi, A. & Banan, B. Clinical, endoscopic and pathologic spectrum of non-steroidal anti-inflammatory drug-induced colitis. Indian J Gastroenterol 28, 150–153 (2009). https://doi.org/10.1007/s12664-009-0053-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-009-0053-9