A study of 41 people aged 22-66 years found evidence of small-bowel injury on capsule endoscopy in 71% of those taking a nonsteroidal anti-inflammatory drug for at least 3 months.
By comparison, 10% of control patients not taking NSAIDs had such injuries—a highly significant difference. While it's known that NSAIDs are associated with small-intestine injuries and may be the cause of unexplained hypoalbuminemia or anemia, the extent of the small-intestine damage had previously not been well characterized, according to the lead investigator, David Y. Graham, M.D., chief of gastroenterology and professor of medicine at Baylor College of Medicine in Houston.
The study does not have clinical implications for managing patients currently, but will serve as a basis of future studies, he said in an interview. The next step is to investigate how these findings correlate with anemia or protein loss and whether NSAIDs vary in their ability to induce these effects, he added.
Patients in the study had various arthritides, but were generally healthy and did not have anemia or hypoalbuminemia. Of the 21 patients on NSAIDs, 5 had major damage defined as having more than four erosions or large ulcers. None of the 20 control patients had major damage (Clin. Gastroenterol. Hepatol. 2005;3:55-9).
The ulcers were more common than anticipated, said Dr. Graham, noting that previous estimates of small-intestine damage associated with NSAIDs have come from autopsy studies, which found a rate of 5%-8%.