Non-steroidal Anti-inflammatory Drug-Induced Entero-colopathy: The Continuing Search for Treatment and Prevention

Abstract

Long-term as well as short-term treatment with non-steroidal anti-inflammatory drugs (NSAID) leads to the development of gastrointestinal tract (GIT) complications during the course of treatment. Complications, such as bleeding, perforation, and obstruction, commonly affect the upper GIT. However, the lower GIT may also be severely affected with NSAID-induced entero-colopathy which occurs more frequently in the small bowel and to a lesser extent in the large bowel. Entero-colopathy is more difficult to treat than NSAID-induced upper GI injury, and to date, there is no proven effective therapy. As the current treatment focuses mainly on the withdrawal of the causative drug, the management is now shifting towards prevention. The search for effective prevention is continuing, and new prevention strategies such as the use of probiotics, teprenone, and others are emerging. They are showing promising cytoprotective properties in the healing of NSAID-induced ulcers. Unfortunately, most of the available evidence on the prevention and treatment is based on animal studies and sporadic case reports in the absence of large randomized controlled studies. This calls for a consolidated effort to establish evidence-based guidelines on the prevention and treatment of NSAID-induced entero-colopathy to halt its rising incidence.