Hidden damage revealed

Nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal lesions should be suspected when a patient receiving NSAID therapy has pain or signs of hemorrhage that are severe enough to warrant an emergency endoscopy. However, with endoscopy, patients receiving NSAID therapy with no particular gastrointestinal symptoms may also be found to have lesions. These lesions are polymorphic in character and lack clear anatomic and clinical parallels with spontaneous lesions. Endoscopically, they are of three types: (1) Advanced focal or diffuse lesions, uncommon and not usually seen in ambulatory patients; (2) large or diffuse, ulcerated or hemorrhagic lesions, that can be differentiated from those seen in typical digestive system pathology; and (3) microlesions, often responsible for false-negative examinations and now detectable through advances in electronic endoscopy. Lower bowel or ileocolonic damage is also a common finding but has only recently come to clinical attention. The endoscopic appearance of these intestinal lesions suggests a superficial inflammatory bowel disease such as hemorrhagic rectocolitis or Crohn's disease.