Graham David Y, Opekun Antone R, Willingham Field F, Qureshi Waqar A
Department of Medicine, VA Medical Center, Room 3A-320 (111D), 2002 Holcombe Boulevard, Houston, Texas 77030, USA.
Clin Gastroenterol Hepatol. 2005 Jan;3(1):55-9. doi: 10.1016/s1542-3565(04)00603-2.
BACKGROUND & AIMS: Patients who regularly take nonsteroidal anti-inflammatory drugs (NSAIDs) have an increased risk for small-intestinal mucosal ulceration and bleeding, which may present as anemia of undetermined gastrointestinal origin or protein loss. The prevalence and severity of small-intestinal lesions remains unclear. Our aim was to assess the frequency of NSAID-induced small-bowel injury among chronic NSAID users.
Ambulatory patients with various types of arthritides who took NSAIDs daily (>3 mo duration) or took either acetaminophen alone or nothing were enrolled in the study. All patients fasted overnight and underwent wireless video capsule endoscopy. Two investigators, blind to therapy, reviewed each video beginning after the pylorus. Lesions were scored as normal, red spots, small erosions, large erosions, or ulcers. An ulcer was defined as a larger lesion with apparent depth and a definite rim.
Forty-one patients, 36 men and 5 women, ages ranging from 22 to 66 years (mean age, 49.8 y) were analyzed including 21 chronic NSAID users and 20 control patients. Small-bowel injury was seen in 71% of NSAID users compared with 10% of controls (P < .001). Injury was mild (few or no erosions, absence of large erosions/ulcers) in 10 NSAID users compared with 2 controls. Five NSAID users had major (>4 erosions or large ulcers/ulcers) damage compared with none in the control group. There were no complications or problems with the capsule endoscopy procedure.
Endoscopically evident small-intestinal mucosal injury is very common among chronic NSAID users. The role of endoscopically evident injury in unexplained iron-deficiency anemia and hypoalbuminemia among chronic NSAID users remains undetermined.
经常服用非甾体抗炎药（NSAIDs）的患者发生小肠黏膜溃疡和出血的风险增加，这可能表现为不明原因的胃肠道源性贫血或蛋白质丢失。小肠病变的患病率和严重程度尚不清楚。我们的目的是评估慢性NSAIDs使用者中NSAID引起的小肠损伤的频率。
纳入每日服用NSAIDs（持续时间>3个月）或仅服用对乙酰氨基酚或未服用任何药物的各种关节炎门诊患者。所有患者过夜禁食并接受无线视频胶囊内镜检查。两名对治疗不知情的研究人员从幽门后开始查看每个视频。病变分为正常、红点、小糜烂、大糜烂或溃疡。溃疡定义为具有明显深度和明确边缘的较大病变。
分析了41例患者，其中36例男性和5例女性，年龄在22至66岁之间（平均年龄49.8岁），包括21名慢性NSAIDs使用者和20名对照患者。71%的NSAIDs使用者出现小肠损伤，而对照组为10%（P<.001）。10名NSAIDs使用者的损伤为轻度（少量或无糜烂，无大糜烂/溃疡），而对照组为2例。5名NSAIDs使用者有严重（>4处糜烂或大溃疡/溃疡）损伤，而对照组无。胶囊内镜检查过程中没有并发症或问题。
内镜可见的小肠黏膜损伤在慢性NSAIDs使用者中非常常见。内镜可见损伤在慢性NSAIDs使用者不明原因的缺铁性贫血和低白蛋白血症中的作用仍未确定。
