1. 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

2. 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:
Upadhyay R, et al. Ann Rheum Dis 1990;49:

3. 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.

4. The Pill Camera Dimensions: Height: 11mm Length: 26mm Weight: 3.7gm
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
8. Antenna
Dimensions:
Height: 11mm
Length: 26mm
Weight: 3.7gm

5. Small Bowel Ulcer

6. NSAID Ulceration

7. Blood in Terminal Ileum

8. A Controlled Study of NSAID-induced Small Bowel Injury Using VCE
Results:
any injury (p<0.001)
Severe damage was associated with high dose indomethacin, naproxen, and ibuprofen use.
NSAID users
Controls
Any injury
71%
10%
Severe injury
20% 0%

9. 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

10. 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

11. THE END