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Proctitis and rectal stenosis induced by nonsteroidal antiinflammatory suppositories
G D'Haens1, Y Breysem, P Rutgeerts
1Department of Internal Medicine, University Hospital, Leuven, Belgium.
Journal of Clinical Gastroenterology
|October 1, 1993
Summary
Analgesic suppository abuse, particularly with acetylsalicylic acid, acetaminophen, and codeine, can cause anorectal ulceration and rectal stenosis. Cessation of drug use, topical steroids, and psychological support are key treatment strategies.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pharmacology
Background:
- Analgesic suppositories containing acetylsalicylic acid, acetaminophen, and codeine are commonly used for pain relief.
- Chronic abuse of these suppositories has been anecdotally linked to gastrointestinal complications.
Observation:
- Ten patients presenting with anorectal ulceration and subsequent rectal stenosis were identified.
- The majority of affected patients were middle-aged women with a history of neurotic or psychiatric conditions.
- Half of the patients exhibited perianal skin lesions.
Findings:
- Endoscopic examination revealed sharply demarcated distal rectal lesions extending from the anal canal, characterized by squamous and transitional epithelium.
- Biopsy results for these lesions were nonspecific, lacking definitive diagnostic features.
- Pathophysiological hypotheses involve mucosal prostaglandin depletion and altered arachidonic acid metabolism due to cyclooxygenase inhibition.
Implications:
- This condition highlights a potential adverse effect of chronic analgesic suppository misuse.
- Treatment necessitates a multimodal approach including drug cessation, anti-inflammatory therapy, and endoscopic interventions.
- Addressing underlying psychological factors is crucial for successful patient management and preventing recurrence.