Risk factors for severe nonsteroidal anti-inflammatory drug-induced small intestinal damage

BackgroundFew studies have assessed the risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced small intestinal damage.AimsTo evaluate the risk factors for NSAID-induced enteropathy in patients with rheumatoid arthritis.MethodsA cross-sectional study using capsule endoscopy was conducted. A total of 113 patients who took NSAIDs for over 3 months underwent capsule endoscopies. Endoscopic findings were scored as (0) normal, (1) red spots, (2) 1–4 erosions, (3) >4 erosions, or (4) large erosions/ulcers. Initial scores were grouped into 3 categories: No damage (0–1), mild damage (2), and severe damage (3–4), and the potential risk factors for damage development were assessed.ResultsFive patients were excluded because of incomplete visualization of the entire small intestine. Fifty-two (47.2%) and 27 (25%) patients had no damage and mild damage, respectively, while the remaining 30 patients (27.8%) had severe damage and significantly decreased hemoglobin levels. In a multivariate logistic regression analysis, ages of 65 years or more (odds ratio [OR], 4.16; 95% confidence interval [CI], 1.51–11.47), proton pump inhibitor usage (OR, 5.22; 95% CI, 1.36–20.11), and histamine H2 receptor antagonist usage (OR, 3.95; 95% CI, 1.28–12.25) were independent risk factors for severe damage.ConclusionsElderly patients and acid suppressant users are more likely to develop severe NSAID-induced enteropathy.