NSAID INJURY TO THE SMALL-INTESTINE

Purpose: To identify the clinical and radiologic findings in patients with diaphragm-like strictures in the small bowel. Patients and method s: We reviewed the histories, radiologic findings, and pathologic find ings in two men and two women, all in their sixties, with a history of long-term nonsteroidal antiinflammatory drug (NSAID) or aspirin (ASA) usage and one or more radiologically demonstrated diaphragm-like stri ctures in the small bowel. Results: Two patients had long histories of NSAID usage, and two of ASA usage, One NSAID user had a long segment of jejunal involvement, and the other three had short segments of duod enal involvement, The ASA users presented with symptoms of esophageal disease, the small bowel lesions were unexpected, and ASA usage was no t initially elicited. In one NSAID user and one ASA user, broader stri ctures with humps rather than diaphragms were also seen producing a li fesaver-like or bagel-like configuration, Conclusions: Multiple diaphr agm-like strictures can occur in NSAID injury and are pathognomonic ex cept in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID i njury and peptic ulceration, ASA should be considered an NSAID with re gard to small-bowel toxicity, A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, a nd a dedicated small bowel examination is required when NSAID injury i s suspected.