SpringerLink
Log in

Endoscopic Features of Chronic Nonspecific Multiple Ulcers of the Small Intestine: Comparison with Nonsteroidal Anti-inflammatory Drug-Induced Enteropathy

  • Original Paper
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Chronic nonspecific multiple ulcers of the small intestine (CNSU) and nonsteroidal anti-inflammatory drug-induced enteropathy (NSAID-enteropathy) share common clinicopathologic features characterized by histologically nonspecific ulcers and persistent blood loss. The aim was to compare enteroscopic findings between CNSU and NSAID-enteropathy. Four patients with CNSU and five patients with NSAID-enteropathy were examined by enteroscopies. The site of involvement was heterogeneous in NSAID-enteropathy, while the ileum was the predominant site in CNSU. Three patients with NSAID-enteropathy and all four patients with CNSU had concentric stenosis. Circular ulcers were found in all five patients with NSAID-enteropathy and in three patients with CNSU. Active ulcer was seen in only two patients with NSAID-enteropathy. In contrast, all four patients with CNSU had active ulcer. These findings suggest that in patients with persistent GI bleeding and enteroscopically active small intestinal ulcers, CNSU, as well as NSAID-enteropathy, should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

Similar content being viewed by others

References

  1. Iddan G, Meron G, Glukhovsky A, Swain P (2000) Wireless capsule endoscopy. Nature 405:17

    Article  Google Scholar 

  2. Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S (2001) Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53:216–220

    Article  PubMed  CAS  Google Scholar 

  3. May A, Nachbar L, Wardak A, Yamamoto H, Ell C (2003) Double-balloon enteroscopy. Preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. Endoscopy 35:985–991

    Article  PubMed  CAS  Google Scholar 

  4. Saurin JC, Delvaux M, Gaudin JL, Fassler I, Villarejo J, Vahedi K (2003) Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: Blinded comparison with video push-enteroscopy. Endoscopy 35:576–584

    Article  PubMed  Google Scholar 

  5. Lewis BS, Swain P (2002) Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: Results of a pilot study. Gastrointest Endosc 56:349–353

    Article  PubMed  Google Scholar 

  6. Ell C, Remke S, May A, Helou L, Henrich R, Mayer G (2002) The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 34:685–689

    Article  PubMed  CAS  Google Scholar 

  7. Adler DG, Knipschield M, Gostout C (2004) A prospective comparison of capsule endoscopy and push enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc 59:492–498

    Article  PubMed  Google Scholar 

  8. Bordas MA, Feu F, Gines A, et al. (2004) Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: A comparative study with push enteroscopy. Aliment Pharmacol Ther 20:189–194

    Article  PubMed  Google Scholar 

  9. Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP (2004) Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: Report of 100 consecutive cases. Gastroenterology 126:643–653

    Article  PubMed  Google Scholar 

  10. Mylonaki M, Frischer-Ravens A, Swain P (2003) Wireless capsule endoscopy: A comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut 52:1122–1126

    Article  PubMed  CAS  Google Scholar 

  11. Matsumoto T, Iida M, Matsui T, Yao T, Yao T, Okabe H (2004) Nonspecific multiple ulcers of the small intestine unrelated to nonsteroidal anti-inflammatory drugs. J Clin Pathol 57:1145–1150

    Article  PubMed  CAS  Google Scholar 

  12. Iida M, Yamamoto T, Yao T, Fuchigami T, Fujishima M (1986) Jejunal endoscopy using a long duodenofiberscope. Gastrointest Endosc 32:233–236

    PubMed  CAS  Google Scholar 

  13. Bjarnason I, Zanelli G, Smith T, Pouse P, Willimas P, Smethurst P (1987) Nonsteroidal anti-inflammatory drug-induced intestinal inflammation in humans. Gastroenterology 93:480–489

    PubMed  CAS  Google Scholar 

  14. Morris AJ, Madhok R, Sturrock RD, Capell HA, MacKenzie JF (1991) Enteroscopic findings of small bowel ulceration in patients receiving non-steroidal anti-inflammatory drugs. Lancet 337:520

    Article  PubMed  CAS  Google Scholar 

  15. Davies GR, Benson MJ, Gertner DJ, van Someren RMN, Rampton DS (1995) Diagnostic and therapeuic push type enteroscopy in clinical use. Gut 37:346–352

    Article  PubMed  CAS  Google Scholar 

  16. Matsushita N, Yamada A, Hiraishi M, et al. (1992) Multiple strictures of he small intestine after long-term nonsteroidal anti-inflammatory drug therapy. Am J Gastroenterol 87:1183–1186

    Google Scholar 

  17. Hershfield NB (1992) Endoscopic demonstration of non-steroidal anti-inflammatory drug-induced small intestinal pathology. Gastrointest Endosc 38:388–390

    Article  PubMed  CAS  Google Scholar 

  18. Acahnta KK, Petros JG, Cave DR, Zinny M (1999) Use of intraoperative enteroscopy to diagnose nonsteroidal anti-inflammatory drug injury to the small intestine. Gastrointest Endosc 49:544– 546

    Article  Google Scholar 

  19. Shumaker DA, Bladen K, Katon RM (2001) NSAID-induced small bowel diaphragms and strictures diagnosed with intraoperative enteroscopy. Can J Gastroenterol 15:619–623

    PubMed  CAS  Google Scholar 

  20. Lang J, Price AB, Levi AJ, Burke M, Gumpel JM, Bjarnason I (1988) Clinicopathological features of nonsteroidal antiinflammatory drug-induced small intestinal strictures. J Clin Pathol 41:516–526

    Article  PubMed  CAS  Google Scholar 

  21. Yousfi MM, de Petris G, Leighton JA, Sharma VK, Pockaj BA, Jaroszewski DE (2004) Diaphragm disease after use of nonsteroidal anti-inflammatory agents. First report of diagnosis with capsule endoscopy. J Clin Gastroenterol 38:686–691

    Article  PubMed  Google Scholar 

  22. Tibble JA, Sigthorsson G, Foster R, Scott D, Fagerhol MK, Roseth A (1999) High prevalence of NSAID enteropathy as shown by a simple faecal test. Gut 45:362–366

    Article  PubMed  CAS  Google Scholar 

  23. Selby W (2004) Can clinical features predict the likelihood of finding abnormalities when using capsule endsocopy in patients with GI bleeding of obscure origin? Gastrointest Endosc 59:782–787

    Article  PubMed  Google Scholar 

  24. Perlemuter G, Guillevin L, Legman P, Weiss L, Couturier D, Caoussade S (2001) Cryptogenic multifocal ulcerous stenosing enteritis. An atypical type of vasculitis or a disease mimicking vasculitis. Gut 48:333–338

    Article  PubMed  CAS  Google Scholar 

  25. Santolaria S, Cabezali R, Ortego J, Castiella T, Salinas JC, Lanas A (2001) Diaphragm disease of the small bowel. A case without apparent nonsteroidal antiinflammatory drug use. J Clin Gastroenterol 32:344–346

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan

    Takayuki Matsumoto, Shotaro Nakamura, Motohiro Esaki, Shinnichiro Yada, Hideki Koga & Mitsuo Iida

  2. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Takashi Yao

Authors
  1. Takayuki Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shotaro Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Motohiro Esaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinnichiro Yada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hideki Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitsuo Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takayuki Matsumoto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matsumoto, T., Nakamura, S., Esaki, M. et al. Endoscopic Features of Chronic Nonspecific Multiple Ulcers of the Small Intestine: Comparison with Nonsteroidal Anti-inflammatory Drug-Induced Enteropathy. Dig Dis Sci 51, 1357–1363 (2006). https://doi.org/10.1007/s10620-006-9080-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9080-x

Keywords

Search

Navigation