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Joint Bone Spine
Volume 72, n° 4
pages 286-294 (juillet 2005)
Doi : 10.1016/j.jbspin.2004.10.004
Received : 24 May 2004 ;  accepted : 4 October 2004
Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum

Gérard Thiéfin a, , Laurent Beaugerie b
a Hepatogastroenterology Department, Robert Debré Teaching Hospital, Reims, France 
b Hepatogastroenterology Federation, Saint-Antoine Teaching Hospital, Paris, France 

*Corresponding author. Service d'Hépato-Gastroentérologie, CHU Robert Debré, rue Général Koenig, 51092 Reims cedex, France. Tel.: +33-3-26-78-72-29; fax: +33-3-26-78-40-61.

The gastrointestinal toxicity of conventional nonsteroidal antiinflammatory drugs (NSAIDs) is not confined to the stomach and proximal duodenum but extends also to the rest of the small bowel, colon, and rectum. Long-term NSAID therapy usually induces clinically silent enteropathy characterized by increased intestinal permeability and inflammation. Chronic occult bleeding and protein loss may result in iron-deficiency anemia and hypoalbuminemia. NSAIDs can also induce small bowel ulcers that infrequently lead to acute bleeding, perforation, or chronic scarring responsible for diaphragm-like strictures. At the colon and rectum, NSAID use can result in de novo lesions such as nonspecific colitis and rectitis, ulcers, and diaphragm-like strictures. NSAIDs have been implicated in the development of segmental ischemic colitis. In patients with diverticular disease, NSAID use increases the risk of severe diverticular infection and perforation. NSAIDs can trigger exacerbations of ulcerative colitis or Crohn's disease. With selective COX-2 inhibitors, the risk of gastrointestinal toxicity is reduced as compared to conventional NSAIDs but is not completely eliminated. Experimental studies suggest that long-term COX-2 inhibitor therapy may cause damage to the previously healthy small bowel. Similar to conventional NSAIDs, COX-2 inhibitors may be capable of triggering exacerbations of inflammatory bowel disease.

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Keywords : Nonsteroidal antiinflammatory drugs, Gastrointestinal toxicity, Gastrointestinal bleeding, Gastrointestinal perforation, Colitis, Diverticular disease, Inflammatory bowel disease

© 2004  Elsevier SAS. All Rights Reserved.
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