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Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations
K Kurahara1, T Matsumoto, M Iida
1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Objective:
Clinical and endoscopic features of nonsteroidal anti-inflammatory drug (NSAID)-induced colonic ulcerations have not been fully investigated.
Methods:
During a 3-yr period from April 1996 to March 1999, 6076 subjects underwent total colonoscopy at our institutions. Among them, the diagnosis of NSAID-induced colonic ulceration was made by their clinical and colonoscopic findings. All patients diagnosed as having this disease underwent upper endoscopy and follow-up colonoscopy. Clinical features, serial changes in colonoscopic findings, and upper GI lesions were analyzed.
Results:
Among the subjects, 14 patients were diagnosed as having NSAID-induced ulcerations. Seven patients were complicated by renal failure. Three patients had gastric ulcers concurrently. Eleven patients had colonic lesions in the ileocecal region. In 13 of 14 patients, initial colonoscopy demonstrated sharply demarcated, semilunar or circumferential ulcers without stricture formation. After discontinuance of NSAIDs, improvement of the ulcers without stricture or inflammatory polyps could be confirmed 3-10 wk later. In one patient with diaphragm-like stricture, follow-up colonoscopy performed 2 yr later demonstrated resolution of circumferential ulcer.
Conclusions:
NSAID-induced colonic ulceration may occur more frequently than previously recognized. Frank ulcerations, rather than stricture formation, seem to be the typical colonoscopic signs of NSAID-induced colonic ulceration.