Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations

OBJECTIVE: Clinical and endoscopic features of nonsteroidal anti-inflammato ry drug (NSAID)-induced colonic ulcerations have not been fully investigate d. METHODS: During a 3-yr period from April 1996 to March 1999, 6076 subjects underwent total colonoscopy at our institutions. Among them, the diagnosis of NSAID-induced colonic ulceration was made by their clinical and colonosc opic findings. All patients diagnosed as having this disease underwent uppe r endoscopy and follow-up colonoscopy. Clinical features, serial changes in colonoscopic findings, and upper GI lesions were analyzed. RESULTS: Among the subjects, 14 patients were diagnosed as having NSAID-ind uced ulcerations. Seven patients were complicated by renal failure. Three p atients had gastric ulcers concurrently. Eleven patients had colonic lesion s in the ileocecal region. In 13 of 14 patients, initial colonoscopy demons trated sharply demarcated, semilunar or circumferential ulcers without stri cture formation. After discontinuance of NSAIDs, improvement of the ulcers without stricture or inflammatory polyps could be confirmed 3-10 wk later. In one patient with diaphragm-like stricture, follow-up colonoscopy perform ed 2 yr later demonstrated resolution of circumferential ulcer. CONCLUSIONS: NSAID-induced colonic ulceration may occur more frequently tha n previously recognized. Frank ulcerations, rather than stricture formation , seem to be the typical colonoscopic signs of NSAID-induced colonic ulcera tion. (C) 2001 by Am. Cell. of Gastroenterology.