Skip to main content
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1988 May;41(5):516–526. doi: 10.1136/jcp.41.5.516

Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs.

J Lang 1, A B Price 1, A J Levi 1, M Burke 1, J M Gumpel 1, I Bjarnason 1
PMCID: PMC1141503  PMID: 3384981

Abstract

Operative small bowel resection specimens received over a period of 16 years were reviewed to assess whether any intestinal disease could be directly attributed to the use of non-steroidal anti-inflammatory drugs (NSAID). Seven cases of intestinal disease associated with the use of NSAID were identified, all of which occurred in the final six years of the survey, which may reflect the increasing use of these compounds. A spectrum of patterns was found from multiple pathognomonic ileal mucosal diaphragms to broad strictures similar to those seen as a complication of enteric potassium. It seems likely that the formation of diaphragm lesions requires an additional factor, but what is not known as yet is whether the effects of NSAID are local or systemic.

Full text

PDF
516

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BOLEY S. J., SCHULTZ L., KRIEGER H., SCHWARTZ S., ELGUEZABAL A., ALLEN A. C. EXPERIMENTAL EVALUATION OF THIAZIDES AND POTASSIUM AS A CAUSE OF SMALL-BOWEL ULCER. JAMA. 1965 May 31;192:763–768. doi: 10.1001/jama.1965.03080220027006. [DOI] [PubMed] [Google Scholar]
  2. Ballantyne K. C., Morris D. L., Hawkey C. J., Hardcastle J. D. Haemorrhage from idiopathic annular ulcers of the small intestine. Ann R Coll Surg Engl. 1986 May;68(3):168–169. [PMC free article] [PubMed] [Google Scholar]
  3. Bayless T. M., Kapelowitz R. F., Shelley W. M., Ballinger W. F., 2nd, Hendrix T. R. Intestinal ulceration--a complication of celiac disease. N Engl J Med. 1967 May 4;276(18):996–1002. doi: 10.1056/NEJM196705042761802. [DOI] [PubMed] [Google Scholar]
  4. Bjarnason I., Zanelli G., Smith T., Prouse P., Williams P., Smethurst P., Delacey G., Gumpel M. J., Levi A. J. Nonsteroidal antiinflammatory drug-induced intestinal inflammation in humans. Gastroenterology. 1987 Sep;93(3):480–489. doi: 10.1016/0016-5085(87)90909-7. [DOI] [PubMed] [Google Scholar]
  5. Cuvelier C., Barbatis C., Mielants H., De Vos M., Roels H., Veys E. Histopathology of intestinal inflammation related to reactive arthritis. Gut. 1987 Apr;28(4):394–401. doi: 10.1136/gut.28.4.394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davies D. R., Brightmore T. Idiopathic and drug-induced ulceration of the small intestine. Br J Surg. 1970 Feb;57(2):134–139. doi: 10.1002/bjs.1800570213. [DOI] [PubMed] [Google Scholar]
  7. Fairweather D. S., Bradwell A. R., Dykes P. W., Vaughan A. T., Watson-James S. F., Chandler S. Improved tumour localisation using indium-111 labelled antibodies. Br Med J (Clin Res Ed) 1983 Jul 16;287(6386):167–170. doi: 10.1136/bmj.287.6386.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fang W. F., Broughton A., Jacobson E. D. Indomethacin-induced intestinal inflammation. Am J Dig Dis. 1977 Sep;22(9):749–760. doi: 10.1007/BF01694504. [DOI] [PubMed] [Google Scholar]
  9. Isaacson P., Wright D. H. Malignant histiocytosis of the intestine. Its relationship to malabsorption and ulcerative jejunitis. Hum Pathol. 1978 Nov;9(6):661–677. doi: 10.1016/s0046-8177(78)80049-5. [DOI] [PubMed] [Google Scholar]
  10. Langman M. J., Morgan L., Worrall A. Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J (Clin Res Ed) 1985 Feb 2;290(6465):347–349. doi: 10.1136/bmj.290.6465.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Madhok R., MacKenzie J. A., Lee F. D., Bruckner F. E., Terry T. R., Sturrock R. D. Small bowel ulceration in patients receiving non-steroidal anti-inflammatory drugs for rheumatoid arthritis. Q J Med. 1986 Jan;58(225):53–58. [PubMed] [Google Scholar]
  12. Mills P. R., Brown I. L., Watkinson G. Idiopathic chronic ulcerative enteritis. Report of five cases and review of the literature. Q J Med. 1980 Spring;49(194):133–149. [PubMed] [Google Scholar]
  13. NADLER S. H., MOORE G. E. AUTOTRANSPLANTATION OF HUMAN CANCER. JAMA. 1965 Jan 11;191:105–106. doi: 10.1001/jama.1965.03080020033009. [DOI] [PubMed] [Google Scholar]
  14. Neoptolemos J. P., Locke T. J. Recurrent small bowel obstruction associated with phenylbutazone. Br J Surg. 1983 Apr;70(4):244–245. doi: 10.1002/bjs.1800700422. [DOI] [PubMed] [Google Scholar]
  15. Nowak J., Wennmalm A. Influence of indomethacin and of prostaglandin E1 on total and regional blood flow in man. Acta Physiol Scand. 1978 Apr;102(4):484–491. doi: 10.1111/j.1748-1716.1978.tb06097.x. [DOI] [PubMed] [Google Scholar]
  16. Price A. B., Morson B. C. Inflammatory bowel disease: the surgical pathology of Crohn's disease and ulcerative colitis. Hum Pathol. 1975 Jan;6(1):7–29. doi: 10.1016/s0046-8177(75)80107-9. [DOI] [PubMed] [Google Scholar]
  17. Regression of atheroma. Br Med J. 1977 Jul 2;2(6078):1–2. [PMC free article] [PubMed] [Google Scholar]
  18. Reid J., Gilmour H. M., Holt S. Primary non-specific ulcer of the small intestine. J R Coll Surg Edinb. 1982 Jul;27(4):228–232. [PubMed] [Google Scholar]
  19. Robertson D. A., Dixon M. F., Scott B. B., Simpson F. G., Losowsky M. S. Small intestinal ulceration: diagnostic difficulties in relation to coeliac disease. Gut. 1983 Jun;24(6):565–574. doi: 10.1136/gut.24.6.565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Satoh H., Guth P. H., Grossman M. I. Role of bacteria in gastric ulceration produced by indomethacin in the rat: cytoprotective action of antibiotics. Gastroenterology. 1983 Mar;84(3):483–489. [PubMed] [Google Scholar]
  21. Saverymuttu S. H., Thomas A., Grundy A., Maxwell J. D. Ileal stricturing after long-term indomethacin treatment. Postgrad Med J. 1986 Oct;62(732):967–968. doi: 10.1136/pgmj.62.732.967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Thomas W. E., Williamson R. C. Enteric ulceration and its complications. World J Surg. 1985 Dec;9(6):876–886. doi: 10.1007/BF01655392. [DOI] [PubMed] [Google Scholar]
  23. Thomas W. E., Williamson R. C. Nonspecific small bowel ulceration. Postgrad Med J. 1985 Jul;61(717):587–591. doi: 10.1136/pgmj.61.717.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Warne P. J., West G. B. Inhibition of leucocyte migration by salicylates and indomethacin. J Pharm Pharmacol. 1978 Dec;30(12):783–785. doi: 10.1111/j.2042-7158.1978.tb13392.x. [DOI] [PubMed] [Google Scholar]
  25. Whittle B. J. Temporal relationship between cyclooxygenase inhibition, as measured by prostacyclin biosynthesis, and the gastrointestinal damage induced by indomethacin in the rat. Gastroenterology. 1981 Jan;80(1):94–98. [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES