NSAID-induced ulcerative ileocolitis

History and Physical Examination: A 67-year-old woman was admitted to our h ospital for spasmodic abdominal pain, diarrhea, and general weakness. She h ad lost 5 kg of weight over the past few weeks. The patient had a 20-year h istory of chronic analgetic abuse, mainly consuming over-the-counter nonste roidal anti-inflammatory drugs (NSAID). Examination: Laboratory examination was remarkable for a low serum albumin (2.3 g/dl), an increased erythrocyte sedimentation rate of 70 mm/h, and a p rofound anemia of 8.5 g/dl. Ultrasound of the abdomen showed thickening of the colonic wall and distended colon loops filled with fluid. On colonoscop y several ulcerations from the sigmoid to the ileum were seen. Histologic e xamination showed a nonspecific ileocolitis. Diagnosis, Therapy and Clinical Course: After cessation of NSAID intake dia rrhea stopped within a few days. Abdominal pain resolved, anemia improved a nd the patient gained weight. A second colonoscopy revealed healing of the colonic ulcerations. Additional examinations regarding differential diagnos es showed no pathological results. Clinical course and subsequent clinical and endoscopic controls revealing further improvement confirmed the diagnos is of an NSAID-induced ileocolitis. Conclusion: This patient is a typical example for NSAID-induced colonic ulc erations. It should be recognized that NSAID induce ulcers not only in the upper gastrointestinal tract. A careful drug history may provide the clue f or the cause of lower gastrointestinal tract ulcerations.