How Capsule Endoscopy Has Illumened the Prevalence of NSAID-Related Distal Small Intestinal Ulceration

Excerpt

The commonly prescribed analgesic and anti-inflammatory medications termed nonsteroidal anti-inflammatory drugs (NSAIDs) induce gastroduodenal ulcerations that in turn are well recognized as the basis for upper gastrointestinal (GI) bleeding and perforation. Though these complications are effectively treated and prevented by the use of proton-pump inhibitors (PPIs), less well appreciated are the ulcerating effects of NSAIDs on the small intestine distal to the second part of the duodenum. Due to the inhibition of the inducible enzyme cyclooxygenase (COX)-2, NSAIDs reduce the production of mucosal prostaglandin E2, a substance responsible for the regulation of the small intestinal microcirculation and the integrity of the mucus barrier [1], while alterations of small intestinal microbiota homeostasis favoring Gram-negative bacteria increase the susceptibility to ulceration in experimental models [2]. The spectrum of endoscopic features of NSAIDs range from mucosal breaks such as erosions and ulcerations to erythema and denuded areas of mucosa [3]. …