Nonsteroidal anti-inflammatory drugs (NSAIDS) may cause disease in the jejunum, ileum and colon as well as the proximal GI tract. The precise mechanisms are unclear, but it may be due to prostaglandin inhibition or a direct toxic effect on the mucosa.


Complications in the small and large bowel may include:

(1) bowel obstruction caused by diaphragm-like strictures associated with proliferation of the muscularis mucosae and/or submucosal fibrosis

(2) inflammation (jejunits, ileitis, colitis)

(3) bleeding

(4) ulceration

(5) perforation

(6) diarrhea


Difficulties in diagnosis:

(1) NSAID use may be unrecognized, unreported or underappreciated by the patient.

(2) The highest use of NSAIDS is in patients with other reasons for intestinal ischemia, bleeding or ulceration.


Unreported NSAID use should be considered in a patient whenever one of the above complications occurs and no other cause can be found. A careful drug history may be able to identify previously unreported use.


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