NSAID-induced deleterious effects on the proximal and mid small bowel in seronegative spondyloarthropathy patients

Abstract

Aim: To investigate the small bowel of seronegative spondyloarthropathy (SpA) patients in order to ascertain the presence of mucosal lesions.

Methods: Between January 2008 and June 2010, 54 consecutive patients were enrolled and submitted to a video capsule endoscopy (VCE) examination. History and demographic data were taken, as well as the history of non-steroidal anti-inflammatory drug (NSAID) consumption. After reading each VCE recording, a capsule endoscopy scoring index for small bowel mucosal inflammatory change (Lewis score) was calculated. Statistical analysis of the data was performed.

Results: The Lewis score for the whole cohort was 397.73. It was higher in the NSAID consumption subgroup (P = 0.036). The difference in Lewis score between NSAID users and non-users was reproduced for the first and second proximal tertiles of the small bowel, but not for its distal third (P values of 0.036, 0.001 and 0.18, respectively). There was no statistical significant difference between the groups with regard to age or sex of the patients.

Conclusion: The intestinal inflammatory involvement of SpA patients is more prominent in NSAID users for the proximal/mid small bowel, but not for its distal part.

Trial registration: ClinicalTrials.gov NCT00768950.

Keywords: Lewis score; Non-steroidal anti-inflammatory drugs; Small bowel mucosal injury; Spondyloarthropathy; Videocapsule endoscopy.

Figures

Figure 1

Comparison between the Lewis scores for the entire small bowel (A), proximal tertile of the small bowel (B), mid tertile of the small bowel (C) and distal tertile of the small bowel (D) in the groups of non-steroidal anti-inflammatory drug users and non-users (the median of values and quartiles represented). NSAID: Non-steroidal anti-inflammatory drug.

Figure 2

Video capsule endoscopy image from the mid jejunum of a 39-year-old male spondyloarthropathy patient, non-steroidal anti-inflammatory drug user, showing a group of small aphthoid ulcerations in a circumscribed area of erythema (blue circle).