INTESTINAL PERMEABILITY AND INFLAMMATION IN PATIENTS ON NSAIDS

Background-The frequency with which non-steroidal anti-inflammatory dr ugs (NSAIDs) increase small intestinal permeability and cause inflamma tion is uncertain. Aims-To examine small intestinal permeability and i nflammation in a large number of patients on long term NSAIDs. Methods -Sixty eight patients receiving six different NSAIDs for over six mont hs underwent combined absorption-permeability tests at three different test dose osmolarities (iso-, hypo-, and hyperosmolar), Two hundred a nd eighty six patients on 12 different NSAIDs underwent indium-lll whi te cell faecal excretion studies to assess the prevalence and severity of intestinal inflammation. Results-The iso- and hyperosmolar test-a showed significant malabsorption of 3-0-methyl-D-glucose, D-xylose, an d L-rhamnose, Intestinal permeability changes were significantly more pronounced and frequent with the hypo- and hyperosmolar as opposed to the isoosmolar test. Sequential studies showed that four and nine pati ents (of 13) developed inflammation after three and six months treatme nt with NSAIDs, respectively. There was no significant difference (p>0 .1) in the prevalence (54-72%) or severity of intestinal inflammation in the 286 patients taking the various NSAIDs apart from those on aspi rin and nabumetone, these having no evidence of intestinal inflammatio n. There was no significant correlation between the inflammatory chang es and age, sex, dose of NSAID, length of disease,or NSAID ingestion. Conclusions-Intestinal permeability test dose composition is an import ant factor when assessing the effects of NSAIDs on intestinal integrit y. All the conventional NSAIDs studied were equally associated with sm all intestinal inflammation apart from aspirin and nabumetone which se em to spare the small bowel.