Long-Term Outcomes of NSAID-Induced Small Intestinal Injury Assessed by Capsule Endoscopy in Korea: A Nationwide Multicenter Retrospective Study

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Authors: Ki-Nam Shim ; Eun Mi Song ; Yoon Tae Jeen ; Jin-Oh Kim ; Seong Ran Jeon ; Dong Kyung Chang ; Hyun Joo Song ; Yun Jeong Lim ; Jin Soo Kim ; Byong Duk Ye ; Cheol Hee Park ; Seong Woo Jeon ; Jae Hee Cheon ; Kwang Jae Lee ; Ji Hyun Kim ; Byung Ik Jang ; Jeong Seop Moon ; Hoon Jae Chun ; Myung-Gyu Choi

MeSH: Age Factors ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects* ; Aspirin/adverse effects ; Capsule Endoscopy* ; Female ; Humans ; Intestinal Diseases/chemically induced ; Intestinal Diseases/pathology* ; Intestine, Small/drug effects* ; Intestine, Small/injuries ; Intestine, Small/pathology* ; Male ; Middle Aged ; Recurrence ; Republic of Korea ; Retrospective Studies ; Time Factors ; Ulcer/chemically induced ; Ulcer/pathology*

Keywords: Anti-inflammatory agents, non-steroidal ; Capsule endoscopy ; Outcome

Abstract: BACKGROUND/AIMS: We evaluated the long-term outcome and clinical course of patients of nonsteroidal anti-inflammatory drug (NSAID)-induced small intestinal injury by performing capsule endoscopy (CE).

METHODS: A multicenter retrospective study was conducted using data collected from the CE nationwide database registry, which has been established since 2002.

RESULTS: A total of 140 patients (87 males; mean age, 60.6±14.8 years) from the CE nationwide database registry (n=2,885) were diagnosed with NSAID-induced small intestinal injury and enrolled in our study. Forty-nine patients (35.0%) presented with a history of aspirin use and an additional 49 (35.0%) were taking NSAIDs without aspirin. The most prominent findings after performing CE were multiple ulcerations (n=82, 58.6%) and erosions or aphthae (n=32, 22.9%). During the follow-up period (mean, 15.9±19.0 months; range, 0 to 106 months), NSAID-induced small intestinal injury only recurred in six patients (4.3%). Older age and hypertension were positive predictive factors for recurrence.

CONCLUSIONS: These results suggest that the recurrence of NSAID-induced small bowel injury was not frequent in the presence of conservative treatment. Therefore, the initial diagnosis using CE and the medication history are important.