Detection and prevention of NSAID-induced enteropathy.

Non-steroidal anti-inflammatory drugs (NSAIDs) may cause damage distal to the duodenum. We reviewed the prevalence, clinical spectrum, assessment, pathogenesis, and treatment of adverse effects of NSAIDs on the small intestine. NSAIDs can cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs produce inflammation of the small intestine in 40 to 70% in long-term users, and the associated complications of blood loss and protein loss are difficult management problems. The pathogenesis of NSAID enteropathy is a multi-stage process involving specific biochemical and subcellular organelle damage followed by inflammatory tissue reaction. Various suggested treatments of NSAID-induced enteropathy (e.g., sulphasalazine, misoprostol, and metronidazole) have yet to undergo rigorous clinical trials. Cyclo-oxygenase-2 inhibitors appear to be safer to the small intestine than traditional NSAIDs. Pre-clinical and clinical data suggests meloxicam, celecoxib, nimesulide and rofecoxib may have less small intestine toxicity than traditional non-selective NSAIDs.