From pain relief to mucosal grief: A comprehensive review of NSAID enteropathy

Non-steroidal anti-inflammatory drugs (NSAIDs) are essential for their analgesic, anti-inflammatory and anti-pyretic properties. However, their extended use can lead to NSAID enteropathy, a frequently underdiagnosed condition of the small intestine. This pathology manifests as mucosal damage, ulcerations, strictures and increased intestinal permeability, potentially resulting in complications such as bleeding, protein loss and nutrient malabsorption. Modern diagnostic technologies, particularly capsule endoscopy, have revealed that small-bowel injury affects up to 70% of chronic NSAID users, although many patients remain asymptomatic. This comprehensive review explores the epidemiology, underlying mechanisms, clinical manifestations, diagnostic approaches and treatment strategies for NSAID enteropathy, while emphasizing the growing importance of increased clinical awareness and continued research into preventive and therapeutic interventions, especially as long-term NSAID use becomes more prevalent in our aging global population.