Chronic NSAID Use: Small Bowel Injury Waqar Qureshi, MD, FACP, FACG Associate Professor of Medicine Chief of Endoscopy Baylor College of Medicine/VAMC Houston, Texas
NSAIDs and the Small Intestine The occasional finding of intestinal blood loss or anemia in the setting of normal upper and lower endoscopy led to the realization that: • NSAID-induced small intestinal ulceration and bleeding were clinically important Hedenbro JL, et al. Gastrointest Endosc 1988;34:247-251 Upadhyay R, et al. Ann Rheum Dis 1990;49:359-362
A Controlled Study of NSAID-induced Small Bowel Injury Using VCE Methods: • 41 ambulatory subjects (mean age = 49.5 y) with various types of arthritides (OA/RA/gout/non-specific) were enrolled • 21 subjects took NSAIDs daily (>3 mo duration) • 20 took acetaminophen alone or nothing.
The Pill Camera 1. Optical dome 2. Lens holder 3. Lens 4. Illuminating LEDs (light emitting diodes) 5. CMOS image sensor 6. Battery 7. ASIC (Application Specific Integrated Circuit) transmitter 8. Antenna Dimensions: Height: 11mm Length: 26mm Weight: 3.7gm
A Controlled Study of NSAID-induced Small Bowel Injury Using VCE Results: any injury (p<0.001) • Severe damage was associated with high dose indomethacin, naproxen, and ibuprofen use.
Conclusions Symptoms and signs of ill-health among chronic NSAID users are often attributed to the underlying disease Possible evidence of NSAID enteropathy includes: • Dyspepsia that does not respond to PPI • Vague abdominal pain that eludes diagnosis or treatment • Iron deficiency anemia • Hypoalbuminemia
NSAID-induced Small Bowel Injury Conclusions • VCE is a useful tool for diagnosing NSAID-induced small intestinal mucosal injury • VCE should be considered in patients on NSAIDs with unexplained symptoms • Prospective comparisons of NSAIDs or other drugs and the GI tract