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Title: Review article: a practical approach to the clinical management of NSAID enteropathy.
Austin Authors: Srinivasan, Ashish ;De Cruz, Peter
Affiliation: Gastroenterology and Hepatology
Department of Medicine, The University of Melbourne, Melbourne, Australia
Issue Date: Sep-2017
Date: 2017-06-06
Publication information: Scandinavian Journal of Gastroenterology 2017; 52(9): 941-947
Abstract: Co-prescription of acid suppressive therapy, together with advances in small bowel imaging techniques, have shifted the burden of NSAID-related toxicity from gastro-duodenal to more distal small bowel injury. Due to predominantly subclinical disease, NSAID enteropathy remains under-recognised, with an incidence of 53-80% amongst healthy short-term users, and a prevalence of 50-71% following long-term (>3 months) use. Despite their distinct pathogenesis, those at risk of NSAID-related gastro-duodenal and small bowel complications share several risk factors. Clinical complications of NSAID enteropathy such as protein-losing enteropathy, small bowel strictures and diaphragm disease, confer significant morbidity, and are often irreversible. Small bowel prophylaxis has proven of modest efficacy after short-term, high-dose NSAID use in asymptomatic patients. While selective COX-2 inhibitors are associated with fewer gastro-duodenal complications relative to non-selective NSAIDs, their comparative benefit in protecting against small bowel enteropathy remains unclear. Prophylaxis should be considered in those at high risk of small bowel complications, as treatment options for established disease remain limited; however, the optimal agent remains unclear. We propose a clinical algorithm that may help prevent, monitor, investigate, and manage the sequelae of NSAID-induced small bowel toxicity.
DOI: 10.1080/00365521.2017.1335769
Journal: Scandinavian Journal of Gastroenterology
PubMed URL: 28587496
Type: Journal Article
Subjects: COX-1/COX-2 inhibition
NSAID enteropathy
capsule endoscopy
diaphragm disease
Risk Factors
small bowel
Appears in Collections:Journal articles

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