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NSAIDs Cause Ulcers and Bleeding in Small Intestine: Presented at DDW

By Mike Fillon

ORLANDO, FL -- May 21, 2003 -- Research using video capsule endoscopy (VCE) shows small intestinal ulcerations, lesions, and bleeding related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) occur 40% more often than previously thought.

Although NSAIDs are known to sometimes cause stomach problems, the prevalence and severity of small intestinal lesions has been unclear, said lead investigator David Y. Graham, MD, speaking here May 19^th at Digestive Disease Week 2003.

"Previously, researchers relied on autopsy studies showing that only a low number of NSAID users had non-specific small intestinal ulcerations," said Dr. Graham. "Through the use of VCE we were finally able to prove that NSAID-related intestinal damage is many times more prevalent than originally thought."

The double-blind study enrolled 40 patients with a mean age of 49.5 years and various types of arthritis. Twenty of them took daily NSAIDs for more than 3 months and 20 took acetaminophen or nothing at all. There was no standard dosage.

After fasting overnight, each subject underwent VCE. The pylorus was marked on each video. Two investigators reviewed each patient, using definite erosions as the critical variable to predict NSAID-induced damage.

Research outcomes show small intestinal damage in the majority of chronic NSAID users. Specifically, results showed 71% of the NSAID users had damage compared to 10% of non-users. Severe injury was seen in 25% of the subjects in the NSAID group compared to in none of the non-users. Severe damage was coupled with high-dose indomethacin, naproxen, and ibuprofen use.

Mucosal injury in the small intestine was identified four times as often using VCE than with investigating autopsy results.

Dr. Graham said the results of this study should lead to future research to identify methods of preventing damage in patients using NSAIDs and equating damage with symptoms.


[Study title: Controlled Study of NSAID-Induced Small Bowel Injury Using Video Capsule Endoscopy. Abstract 104105]

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