We reviewed the literature regarding the epidemiology, diagnosis and treatments of nonsteroidal nti-inflammatory drug (NSAID)-induced enteropathy. The prevalence of NSAIDs-induced enteropathy is higher than had been expected . Recent studies showed more than 50% of patients taking NSAIDs had some mucosal changes in the small intestine. The gross appearance of NSAID-induced enteropathy varies ; diaphragm-like strictures, deep ulcers resulting in perforation, round or oval ulcers, circular ulcers, hemorrhagic ulcers or erosions and mucosal redness. Capsule endoscopy and double-balloon enteroscopy are helpful for making a diagnosis of NSAID-induced enteropathy. To investigate NSAID-induced enteropathy simply, and to rule out other specific enteropathies, such modalities as radiological examination of the small intestine, the permeability test, scintigraphy or the fecal excretion test using 111In-labelled white blood cells, and measurement of the fecal calprotectin concentration are also useful in addition to these enteroscopic examinations. Misoprostol, metronidazole and sulf asalazine are frequently used to treat NSAID-induced enteropathy, but have undesirable effects in some cases. Therefore, prevention of NSAID-induced enteropathy with selective COX-2 inhibitors may be also important . In the future, the development of new drugs based on the possible mechanisms of NSAID-induced mucosal inflammation is expected. Diaphragm-like strictures and bleeding from mucosal breaks may be treatable with interventional enteroscopy.
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