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NSAR-Kolopathie

NSAID-colonopathy

Der Pathologe volume 27, pages 65–72 (2006)Cite this article

Zusammenfassung

Schon lange sind die schmerzstillenden Eigenschaften von NSAR/ASS-Präparaten bekannt. Besonders der Gastrointestinaltrakt ist von Nebenwirkungen wie Einblutungen, Erosionen, Ulzerationen und Perforationen betroffen. Für den oberen Gastrointestinaltrakt konnte unsere Gruppe in einem großen Prozentsatz histologisch die korrekte Diagnose einer NSAR/ASS-induzierten Läsion auf der Basis einer ischämischen Genese stellen. Seltener können auch im unteren Gastrointestinaltrakt NASR/ASS-induzierte Läsionen beobachtet werden. Unsere Arbeitsgruppe konnte auch hier zeigen, dass in einem hohen Prozentsatz die Diagnose einer NSAR-Kolopathie auf der Basis einer ischämischen Nekrose histologisch richtig gestellt werden kann.

Neben den bekannten Komplikationen wie Ulzerationen mit Perforation können im Dünn- und Dickdarm darüber hinaus diaphragmaartige Stenosen als Folge einer NSAR-Einnahme beobachtet werden, die nicht mit Tumorstenosen verwechselt werden dürfen.

Rein histologisch ist eine ischämische Kolitis nicht von einer NSAR-induzierten Läsion zu unterscheiden. Notwendig sind daher die Ergebnisse der Endoskopie. Zuweilen werden die Veränderungen aufgrund des diskontinuierlichen Charakters auch als Morbus Crohn fehlinterpretiert.

Da all unsere Analysen retrospektiver Natur sind, sollten die Ergebnisse in prospektiven Studien geprüft werden.

Abstract

The pain-relief properties of NSAID/ASA preparations have been known for a long time. In particular, the gastrointestinal tract shows side effects such as: erosion, ulceration, and even perforation. In the upper gastrointestinal tract, our group has shown that a correct histological diagnosis of NSAID/ASA induced lesions can be made in a high percentage of cases on the basis of recognition of ischemic necrosis. NSAID/ASA induced lesions are less commonly found in the lower gastrointestinal tract. We could also demonstrate a correct histological diagnosis of NSAID-colonopathy on the basis of finding ischemic necrosis.

Besides the known complications, another typical complication is diaphragm-like stenosis, which must not be mistaken for tumor stenosis.

The differential diagnosis of NSAID-colonopathy includes ischemic colitis, which cannot be distinguished histologically if the exact endoscopic description is not available. Sometimes NSAID/ASA induced lesions are misdiagnosed as Crohn’s disease due to the focal character of the lesions.

Since all of our analyses are retrospective, the criteria developed by our group should be checked prospectively.

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Literatur

  1. Appleyard CB, McCafferty DM, Tigley AW et al. (1996) Tumor necrosis factor mediation of NSAID-induced gastric damage: role of leukocyte adherence. Am J Physiol 270:G42–G48

    PubMed  Google Scholar 

  2. Bjarnason I, Price AB, Zanelli G et al. (1988) Clinicopathological features of nonsteroidal anti-inflammatory drug induced small intestinal strictures. Gastroenterology 94:1070–1074

    PubMed  Google Scholar 

  3. Bjarnason I, Takeuchi K, Simpson R (2003) NSAIDs: the emperor’s new dogma? Gut 52:1376–1378

    Article  PubMed  Google Scholar 

  4. Bombardier C, Laine L, Reicin A et al. (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 343:1520–1528

    PubMed  Google Scholar 

  5. Brune K, Schweitzer A, Eckert A (1977) Parietal cells of the stomach trap salicylates during absorption. Biochem Pharmacol 26:1735–1740

    Article  PubMed  Google Scholar 

  6. Campbell K, Steele RJC (1991) Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case-control study. Br J Surg 78:190–191

    PubMed  Google Scholar 

  7. Davies NM (1995) Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine. Dis Colon Rectum 38:1311–1321

    Article  PubMed  Google Scholar 

  8. Douthwaite AH, Lintott GA (1938) Gastroscopic observation of the effect of aspirin and certain other systances on stomach. Lancet 2:1222–1225

    Article  Google Scholar 

  9. Evans SM, Whittle BJR (2001) Interactive roles of superoxide and inducible nitric oxide synthase in rat intestinal injury provoked by non-steroidal anti-inflammatory drugs. Eur J Pharmacol 429:287–296

    Article  PubMed  Google Scholar 

  10. Fellows IW, Clarke JM, Roberts PF (1992) Non-steroidal anti-inflammatory drug-induced jejunal and colonic diaphragm disease: a report of two cases. Gut 33:1424–1426

    PubMed  Google Scholar 

  11. Giraud MN, Motta C, Romero JJ, Lichtenberger LM (1999) Interaction of indomethacin and naproxen with gastric surface-active phospholipids: a possible mechanism from the gastric toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs). Biochem Pharmacol 57:247–254

    Article  PubMed  Google Scholar 

  12. Gryglewski RJ, Palmer RM, Moncada S (1986) Superoxide anion is involved in the breakdown of endothelium-derived vascular relaxing factor. Nature 320:454–456

    Article  PubMed  Google Scholar 

  13. Halter F, Weber B, Huber T et al. (1993) Diaphragm disease of the ascending colon. Association with sustained-release diclofenac. J Clin Gastroenterol 61:74–80

    Google Scholar 

  14. Karcher LF, Dill SG, Anderson WI, King JM (1990) Right dorsal colitis. J Vet Intern Med 4:247–253

    PubMed  Google Scholar 

  15. Klee M, Vogel CU, Diehl HG, Stolte M (1998) Das Diaphragma-Kolon—Eine schwerwiegende Nebenwirkung nichtsteroidaler Antirheumatika (NSAR). Leber Magen Darm 28:137–141

    Google Scholar 

  16. Laine L, Connors LG, Reicin A et al. (2003) Serious lower gastrointestinal clinical events with nonselective NSAID or coxib use. Gastroenterology 124:288–292

    Article  PubMed  Google Scholar 

  17. Lanas A, Serrano P, Bajador E et al. (1997) Evidence of aspirin use in both upper and lower gastrointestinal perforation. Gastroenterology 112:683–689

    Article  PubMed  Google Scholar 

  18. Lang J, Price AB, Levi AJ et al. (1988) Diaphragm disease: pathology of disease of small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol 41:516–526

    PubMed  Google Scholar 

  19. Langman MJS, Morgan L, Worrall A (1985) Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J 290:347–349

    Google Scholar 

  20. Lichtenberger LM, Wang ZM, Romero JJ et al. (1995) Non-steroidal anti-inflammatory drugs (NSAIDs) associate with zwitterionic phospholipids: insight into the mechanism and reversal of NSAID-induced gastrointestinal injury. Nat Med 1:154–158

    Article  PubMed  Google Scholar 

  21. MacDonald PH (2002) Ischaemic colitis. Best Pract Res Clin Gastroenterol 16:51–61

    Article  PubMed  Google Scholar 

  22. Mahmud T, Rafi SS, Scott DL et al. (1996) Nonsteroidal antiinflammatory drugs and uncoupling of mitochondrial oxidative phosphorylation. Arthritis Rheum 39:1998–2003

    PubMed  Google Scholar 

  23. Pihan GRC, Szabo S (1988) Vascular injury in acute gastric mucosa damage. Mediatory role of leucotrienes. Dig Dis Sci 33:625–632

    Article  PubMed  Google Scholar 

  24. Rockall TA, Logan RF, Devlin HB (1995) Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 311:222–226

    PubMed  Google Scholar 

  25. Rothlein R, Czajkowski M, Kishimoto TK (1991) Intercellular adhesion molecule-1 in inflammatory response. Chem Immunol 50:135–142

    PubMed  Google Scholar 

  26. Sacanella E, Munoz F, Cardellach F et al. (1996) Massive haemorrhage due to colitis secondary to nonsteroidal anti-inflammatory drugs. Postgrad Med J 72:57–58

    PubMed  Google Scholar 

  27. Singh G, Ramey DR (1998) NSAID induced gastrointestinal complications: the ARAMIS perspective—1997. Arthritis, Rheumatism, and Aging Medical Information System. J Rheumatol 25 [Suppl 51]:8–16

    Google Scholar 

  28. Smale S, Natt RS, Orchard TR (2001) Inflammatory bowel disease and spondylarthropathy. Arthritis Rheum 44:2728–2726

    Article  PubMed  Google Scholar 

  29. Soll A, McCarthy D (1999) NSAID-related gastrointestinal complications. Clin Cornerstone 1:42–56

    Article  PubMed  Google Scholar 

  30. Stolte M, Panayiotou S, Schmitz J (1999) Can NSAID/ASA-induced erosions of the gastric mucosa be indentified at histology? Pathol Res Pract 195:137–142

    PubMed  Google Scholar 

  31. Stolte M, Karimi D, Vieth M et al. (2005) Strictures, diaphragms, erosions or ulcerations of the ischaemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drugs-induced lesions. World J Gastroenterol 11:5828–5833

    PubMed  Google Scholar 

  32. Stone E (1763) An account of the success of the bark of the willow in the cure of agues. Philosophical Transactions 53:195–200

    Google Scholar 

  33. Sturges HFLKC (1973) Ulcerations and stricture of the jejunum in a patient of long-term indomethacin therapy. Am J Gastroenterol 59:162–169

    PubMed  Google Scholar 

  34. The RISC Group (1990) Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 336:827–830

    Article  PubMed  Google Scholar 

  35. The SALT Collaborative Group (1991) Swedish Aspirin Low-Dose Trial/SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 338:1345–1349

    Article  PubMed  Google Scholar 

  36. Vieth M, Müller H, Stolte M (2002) Can the diagnosis of NSAID-induced or Hp-associated gastric ulceration be predicted from histology? Z Gastroenterol 40:783–788

    Article  PubMed  Google Scholar 

  37. Wallace JLAKE, McKnight GW (1991) A monoclonal antibody against the CK 18 leucocyte adhesion molecule prevents indomethacin-induced gastric damage in the rabbit. Gastroenterology 100:878–893

    PubMed  Google Scholar 

  38. Wilcox CM, Alexander LN, Cotsonis GA, Clark WS (1997) Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci 42:990–997

    Article  PubMed  Google Scholar 

  39. Zimmermann F (2004) Schmerz. In: Schwabe U, Paffrath D (Hrsg) Arzneimittelverordnungs-Report.

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  1. Institut für Pathologie, Klinikum Bayreuth

    M. Vieth

  2. Institut für Pathologie, Klinikum Bayreuth GmbH, Preuschwitzer Straße 101, 95445, Bayreuth

    M. Vieth

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  1. M. Vieth
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Correspondence to M. Vieth.

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Herrn Professor Stolte zum 65. Geburtstag gewidmet.

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Vieth, M. NSAR-Kolopathie. Pathologe 27, 65–72 (2006). https://doi.org/10.1007/s00292-005-0810-1

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Schlüsselwörter

  • Nichtsteroidale Antirheumatika (NSAR)
  • Acetylsalicylsäure (ASS)
  • Kolopathie
  • Ischämische Kolitis

Keywords

  • Non-steroid anti-inflammatory drugs
  • Acetylsalicylic acid
  • Colitis
  • Diaphragm
  • Ischemic necrosis