A CASE OF NON-STEROIDAL ANTI-INFLAMMATORY DRUG-INDUCED SMALL INTESTINAL ULCER AND STRICTURE

Abstract

Mucosal damages in the small intestine due to non-steroidal anti-inflammatory drugs (NSAIDs) have been called attension as the "diaphragm disease". A 62-year-old female had been administered 150mg/day of diclof enac sodium in the form of suppositories for about 5 years to treat rheumatoid arthritis. Because of right lower abdominal pain colonoscopy was performed, revealing a shallow annular ulcer and intestinal stenosis in the terminal ileum. Infiltration of inflammatory cells, mainly lymphocytes, and fibrous connective tissues were found histologically in biopsy specimens taken from the lesion, but there were no specific findings such as granuloma formation or vasculitis. Based on these findings, a small intestinal ulcer caused by NSAIDs was suspected. Administration of the NSAID was discontiued and the ulcers had disappeared one month later at the time of colonoscopy. As the etiology, it is considered that NSAIDs may involve disturbances in the intestinal wall barrier mechanism and reduce prostaglandin synthesis in the mucosa. The so-called diaphragm disease with endoscopic findings of small intestinal lesions due to NSAIDs is rare and was reported here in.