Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding

Abstract Background: Small bowel (SB) bleeding has been known to account for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Although angioectasia is the common etiology of SB bleeding, non-steroidal anti-inflammatory drug (NSAID)-induced SB lesion is also reported as a major cause in previous studies from the Eastern countries. Herein, we assessed the frequency of NSAID-induced SB lesion in Korean patients with obscure GI bleeding. Methods: We retrospectively analyzed medical records of all consecutive patients aged ≥18 years who underwent capsule endoscopy from March 2018 to February 2019 at Ulsan University Hospital and Kosin University Gospel Hospital. Results: Of the 83 subjects (age, mean ± standard deviation: 59 ± 18 years; age range: 18–84 years; men, n=52; women, n=31), 55 (66.2%) had a clear bloody stool and 28 (33.8%) had a normal stool, but all had iron deficiency anemia. A significantly higher frequency (40 of 51) of ulcerative/erosive lesions was observed in patients with inactive bleeding but visible SB lesions than other causes, and as a result, NSAID-induced enteropathy accounted for 41.7% (25 of 60) of all SB bleeding cases. Conclusions: Contrary to findings of previous studies from the Western countries, ulcerative/erosive lesions were found to have higher occurrence than angioectasia in this study, with an implication of NSAIDs in the etiology of obscure GI bleeding. Aggressive small intestine examination is required for patients with unexplained GI bleeding.