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NSAIDs-induced diaphragm-like colonic strictures: a case report
Abdul Hakeem1, Sairam Subramonia, Krishnamurthy Badrinath
1King's Mill Hospital, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire NG17 4JL, UK.
BMJ Case Reports
|June 21, 2011
Summary
Long-term diclofenac use can cause severe colon strictures, leading to iron deficiency anemia. Stopping the nonsteroidal anti-inflammatory drug (NSAID) resolved the patient's symptoms.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pharmacology
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain relief.
- NSAID-induced enteropathy can manifest in various ways, including strictures.
- Chronic use of enteric-coated diclofenac is associated with gastrointestinal side effects.
Purpose of the Study:
- To report a case of severe transverse colon strictures caused by long-term diclofenac use.
- To highlight the diagnostic challenges and treatment outcomes in NSAID-induced colonic injury.
- To emphasize the importance of considering medication history in patients with unexplained gastrointestinal symptoms.
Main Methods:
- A case report of a 48-year-old woman with a 2-week history of diarrhea and abdominal pain.
- Clinical examination revealed subconjunctival pallor and laboratory tests showed iron deficiency anemia (hemoglobin 7.1 g/dl).
- Colonoscopy identified two transverse colon strictures with ulceration and inflammation; biopsies showed chronic inflammation with eosinophils.
Main Results:
- The patient had a 10-year history of taking enteric-coated diclofenac 50 mg three times daily for chronic backache.
- Colonoscopy revealed significant ulceration, inflammation, and an impassable diaphragm-like stricture in the transverse colon.
- Bowel symptoms resolved significantly within 4 weeks of discontinuing diclofenac, with sustained improvement at 3 months.
Conclusions:
- Long-term diclofenac use can lead to severe, symptomatic colonic strictures mimicking inflammatory bowel disease or malignancy.
- Discontinuation of the offending NSAID is crucial for symptom resolution in drug-induced enteropathy.
- A thorough medication history is essential for diagnosing NSAID-induced gastrointestinal complications.
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