| Theme | Systemic disease-associated intestinal involvement -- Intestinal Behçet's disease and its differential diagnosis | |
|---|---|---|
| Title | NSAID-induced enteropathy | |
| Publish Date | 2019/11 | |
| Author | Hiroyuki Imaeda | Department of Gastroenterology, Saitama Medical University |
| Author | Minoru Yamaoka | Department of General Internal Medicine, Saitama Medical University |
| Author | Yoshikazu Tsuzuki | Department of Gastroenterology, Saitama Medical University |
| Author | Keigo Ashitani | Department of General Internal Medicine, Saitama Medical University |
| Author | Hisashi Matsumoto | Department of General Internal Medicine, Saitama Medical University |
| Author | Kazuya Miyaguchi | Department of General Internal Medicine, Saitama Medical University |
| Author | Hideki Ohgo | Department of Gastroenterology, Saitama Medical University |
| Author | Hidetomo Nakamoto | Department of General Internal Medicine, Saitama Medical University |
| [ Summary ] | Non-steroidal anti-inflammatory drug (NSAID)-induced small intestinal lesions have become apparent with capsule endoscopy and balloon-assisted endoscopy. The mechanisms are intracellular mitochondrial damage, weakening of tight junctions between cells, apoptosis and necrosis, reduced mucus secretion and microcirculation disturbances due to COX-1 inhibition, and infl ammation due to invasion of bile acids, microbiota, proteolytic enzymes, and food. Involvement of dysbiosis by PPI has also been reported. Most symptoms are anemia, bloody stool, diarrhea, and abdominal pain. Endoscopic findings reveal redness, denuded areas, erosions, aphtoid ulcers, punched ulcers, annular ulcers, and diaphragm. Therapies are discontinuation of NSAIDs and changes to COX-2 selective inhibitors or other analgesics. Efficacy for prevention of mucosal protective drugs such as misoprostol and rebamipide, antibiotics, and probiotics have been reported. | |