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Nonsteroidal anti-inflammatory drug-induced acute ulcers in the colon

Nonsteroidal anti-inflammatory drug (NSAID) colitis is a clinically significant disease, which may present with diarrhea, anemia, and nonspecific abdominal complaints. The definition of NSAID colitis is: endoscopy changes (not necessarily with formed diaphragm, capsule endoscopy not obligatory) plus history of taking NSAID on a regular basis or on demand basis plus clinical symptoms (sideropenic anemia, or diarrhea, or abdominal pain, or combination) plus histology that excludes malignancy, Crohn’s disease or acute infection or histology that directly proves enhanced submucosal fibrosis (the latter is hard to document since the biopsies are usually obtained from the mucosa) [1]. NSAIDs may also cause acute damage and ulcers not only to the upper gastrointestinal tract but also to the small and large intestine [2]. Careful history taking, together with awareness of endoscopic and histological findings, allows a timely diagnosis of this disease. The patient whose figure is presented herein (Fig. 1) was admitted because of acute lower gastrointestinal bleeding after intake of only one capsule of niflumic acid. Bleeding subsided spontaneously and two days afterwards colonoscopy revealed acute small ulcers in the otherwise normal sigmoid colon. Further clinical work up resulted in established final diagnosis of NSAID-induced acute ulcers. 
 
 
 
Figure 1 
 
Acute small ulcers in the sigmoid colon of a patient using nonsteroid anti-inflammatory drugs