ABSTRACT
More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Gastrointestinal Diseases/chemically induced , Age Factors , Endoscopy, Gastrointestinal , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Humans , Mexico , Risk FactorsSubject(s)
Clostridioides difficile , Diarrhea/therapy , Enterocolitis, Pseudomembranous/therapy , Adult , Child , Chronic Disease , Diagnosis, Differential , Diarrhea/epidemiology , Diarrhea/etiology , Enterocolitis, Pseudomembranous/complications , Enterocolitis, Pseudomembranous/epidemiology , Humans , PrognosisABSTRACT
INTRODUCTION AND OBJECTIVES: Capsule endoscopy constitutes a non invasive method used for direct observation of the small bowel's mucosae and for recognizing possible injuries in it, such as the causes of obscure gastrointestinal hemorrhage and inflammatory diseases, for instance. The present study shows the experience obtained in a private hospital using capsule endoscopy for evaluating diverse intestinal pathologies. MATERIALS AND METHODS: Ambulatory patients were evaluated, and the results analyzed in a retrospective, observational and transverse manner. The Given Imaging PillCam was used in all cases. RESULTS: Forty five cases were evaluated; 27 of them (60%) were female, 18 were male (40%). The mean age was 58.16, ranging from 18 to 84 years. Obscure gastrointestinal bleeding constituted the most common indication for undergoing capsule endoscopy; present in 32 patients (71.11% of the cases). Other indications were: chronic diarrhea 5 cases (11.11%), abdominal pain 3 cases (6.67%) and melena 3 cases (6.67%). 18 cases presented no anomaly (40%). The most frequent pathological findings were: erosions 10 cases (22.20%), vascular disorders 8 cases (17.76%) and polyps 6 cases (13.32%). No complications were presented during or after the procedures, although in two of the cases the capsule had to be inserted under endoscopic assistance with sedation. CONCLUSIONS: Capsule endoscopy is an innocuous, safe method, useful in identifying causes of obscure gastrointestinal bleeding, which is the most common indication for the study, and in identifying diverse small bowel pathologies.
