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NSAID damage to the intestine

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NSAID damage to the intestine Powered By Docstoc
					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   Dimensions:
 8. Antenna                         Height: 11mm
                                    Length: 26mm
                                    Weight: 3.7gm
Small Bowel Ulcer
NSAID Ulceration
Blood in Terminal Ileum
    A Controlled Study of NSAID-induced
       Small Bowel Injury Using VCE
Results:
                      NSAID users    Controls
       Any injury        71%          10%
      Severe injury      20%           0%

                         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
THE END

				
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posted:1/26/2013
language:English
pages:11