Non-steroidal Anti-inflammatory Drug Enteropathy

While upper GI complications secondary to NSAIDs have decreased, the incidence of a non-steroidal anti-inflammatory drug (NSAID) induced enteropathy is increasing, as are its serious clinical complications. The pathogenesis of NSAID enteropathy has suggested mechanisms related to cyclooxygenase and local mucosal damage including “three-hit hypothesis.” Symptoms of NSAID enteropathy are usually non-specific, but complications such as iron deficiency anemia, protein-losing enteropathy, and diaphragm-like strictures are possible. In rare cases, this enteropathy may cause life-threatening hemorrhage, intestinal obstruction, and perforation. Therefore, a careful history of taking NSAIDs and aggressive small bowel examination of suspected patients is required. There are no standard treatments at present; however, selective COX-2 inhibitors, mucosal protective agents (e.g., rebamipide), antibiotics, and probiotics are reported to be useful.