Non-steroidal anti-inflammatory drugs and capsule endoscopy—spectrum of presentation and longitudinal follow-up

Background/Objectives: Non-steroidal anti-inflammatory drug (NSAID)-induced small bowel (SB) injuries have a variable clinical and endoscopic presentation. Limited data exists regarding their long-term outcomes, natural course, and discerning factors and differentiation from Crohn’s disease (CD). This study aims to evaluate the spectrum of presentation at capsule endoscopy (CE) and outcome in patients with documented NSAID use.

Methods: We retrospectively evaluated all CEs performed at our hospital from 2014 to July 2023 in patients with documented NSAID use and with SB injury on CE. Patients’ demographics, clinical and endoscopic data, CE findings and outcome were recorded.

Results: A total of 52 patients (33 females; median age 54 years, IQR 41–65) with documented NSAID use who underwent CE were included. The most prominent findings were erosions (56%) and superficial (46%) and deep ulcers (21%). Median follow-up time was 16 months (IQR 4–57). A total of 26 (50%) patients underwent repeat CE after a median interval of 12 months (IQR 10–15). In 77% (n = 20) of patients, SB injury was still present, with the majority (80%) having a Lewis score of < 790. Overall, compared to the previous CE, there were no changes in 35% of cases, worse appearance in 35%, and an improvement in 30%. SB CD was diagnosed in 7 out of 26 patients on follow-up. There were no statistically significant clinical or endoscopic differences between those with NSAID enteropathy and those diagnosed with CD.

Conclusions: NSAID enteropathy presents with a wide spectrum of SB injuries, which cannot be differentiated on CE images alone. This highlights the importance of the clinical picture in the diagnostic process of these patients. Furthermore, our study demonstrated that a percentage of patients still exhibit some degree of SB damage despite cessation of NSAIDs for several months.