Nonsteroidal anti-inflammatory drug-induced
acute ulcers in the colon

Konstantinos H. Katsanos, Dimitrios E. Sigounas, Dimitrios K. Christodoulou,
Epameinondas V. Tsianos

Medical School of Ioannina, Greece

1st Department of Internal Medicine & Hepato-Gastroenterology Unit, Medical School, University of Ioannina, Greece

Conflict of interest: None

Correspondence to: Prof. Epameinondas V. Tsianos, MD, Ph.D, AGAF, Professor of Internal Medicine, Department of Internal Medicine, Medical School, University of Ioannina,
Leoforos Panepistimiou, 45 110 Ioannina, tel: +30-26510-07501,
fax: +30-26510-07016, e-mail: etsianos@uoi.gr

Received 19 January 2011 ; accepted 26 January 2011

Nonsteroidal anti-inflammatory drug (NSAID) colitis is a clinically significant disease, which may present with diarrhea, anemia, and nonspecific abdominal complaints. The definition of NSAID colitis is: endoscopy changes (not necessarily with formed diaphragm, capsule endoscopy not obligatory) plus history of taking NSAID on a regular basis or on demand basis plus clinical symptoms (sideropenic anemia, or diarrhea, or abdominal pain, or combination) plus histology that excludes malignancy, Crohn’s disease or acute infection or histology that directly proves enhanced submucosal fibrosis (the latter is hard to document since the biopsies are usually obtained from the mucosa) [1]. NSAIDs may also cause acute damage and ulcers not only to the upper gastrointestinal tract but also to the small and large intestine [2]. Careful history taking, together with awareness of endoscopic and histological findings, allows a timely diagnosis of this disease.

The patient whose figure is presented herein (Fig. 1) was admitted because of acute lower gastrointestinal bleeding after intake of only one capsule of niflumic acid. Bleeding subsided spontaneously and two days afterwards colonoscopy revealed acute small ulcers in the otherwise normal sigmoid colon. Further clinical work up resulted in established final diagnosis of NSAID-induced acute ulcers.

References

1. Puspok A, Kiener HP, Oberhuber G. Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. Dis Colon Rectum 2000;43:685-691.

2. Katsinelos P, Christodoulou K, Pilpilidis I, et al. Colopathy associated with the systemic use of nonsteroidal antiinflammatory medications. An underestimated entity. Hepatogastroenterology 2002;4944:345-348.