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Intestinal permeability in the pathogenesis of NSAID-induced enteropathy

Journal of Gastroenterology volume 44, pages 23–29 (2009)Cite this article

Abstract

Background

The pathogenesis of nonsteroidal antiinflammatory drug (NSAID)-induced small bowel disease suggests that increased intestinal permeability is the central mechanism that translates biochemical damage to tissue damage. The purpose of this review is to summarize studies on the effect of NSAIDs to increase intestinal permeability in humans and methods for limiting this effect.

Methods

A Medline search was made for papers that described measurements of increased intestinal permeability in humans.

Results

Virtually all studies agree that all conventional NSAIDs increase intestinal permeability in the human within 24 h of ingestion and that this is equally evident when they are taken long term. Various methods have been tried to limit the damage. The most promising agents are coadministration of synthetic prostaglandins, micronutrients, pre-NSAIDs, and COX-2 selective agents. However, their efficacy in preventing the development of NSAID enteropathy in the long term has not been studied in detail, and, in the case of COX-2 selective agents, small bowel damage is comparable to that which is seen with conventional NSAIDs.

Conclusions

NSAID enteropathy is associated with significant morbidity and occasionally mortality. There are no proven effective ways of preventing this damage. Because increased intestinal permeability appears to be a central mechanism in the pathogenesis of NSAID enteropathy, it becomes a potential therapeutic target for prevention. At present there are a number of ways to limit the increased permeability, but additional studies are required to assess if this approach reduces the prevalence and severity of NSAID enteropathy.

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Authors and Affiliations

  1. Department of Gastroenterology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Ingvar Bjarnason

  2. Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan

    Ken Takeuchi

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Bjarnason, I., Takeuchi, K. Intestinal permeability in the pathogenesis of NSAID-induced enteropathy. J Gastroenterol 44, 23–29 (2009). https://doi.org/10.1007/s00535-008-2266-6

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Key words

  • NSAIDs
  • intestinal toxicity
  • intestinal inflammation
  • intestinal permeability