Nonsteroidal Antiinflammatory Drugs as a Risk Factor for Acute Diarrhea: A Case Crossover Study
Abstract & Commentary
Synopsis: Recent NSAID use is a risk factor for acute diarrhea, a consideration for general physicians along with GI specialists.
Source: Etienney I, et al. Gut. 2003;52:260-263.
Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used. It is widely appreciated that they can lead to upper gastrointestinal mucosal lesions. More recent data have verified that NSAIDs also can damage the small intestine and colon, including up to 60% demonstrable enteropathy, as well as cases of severe colitis. NSAIDs may also be related to ischemic colitis or to activation of idiopathic inflammatory bowel disease. However, there are few data describing diarrhea as a common sequela of NSAID use.
The present study was a large physician survey in France regarding patients presenting with acute diarrhea including a specific history of NSAID exposure to any of 12 different NSAIDs during several intervals prior to diarrhea onset. All of these patients were felt to have diarrhea of sufficient severity to warrant a stool study (approximately 5% of all acute diarrhea cases in general practice). Relative risk of diarrhea was dramatically increased after NSAID therapy after 1 or 3 or 6 days of exposure to NSAIDs. Intestinal pathogens were found in 16.8% of cases. Diarrhea had been present for an average of 5 days (1 to 30 days) with bleeding in 10% of patients and fever in 44% of patients.
Comment by Malcolm Robinson MD, FACP, FACG
It seems likely that severe NSAID colitis represents an extreme consequence of nonsteroidal drug administration. However, all physicians should be aware that NSAIDs can be a significant risk factor for acute diarrhea in general. Discontinuation of NSAID therapy may well prove to be adequate therapy for many of these patients.
Dr. Robinson is Medical Director, Oklahoma Foundation for Digestive Research and Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK.
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