The effect of diclofenac on the small intestine studied by wireless endoscopy.

INTRODUCTION: It is well known that NSAIDs cause erosions and ulcers in the stomach and duodenum but little is known about a possible damage to the small intestine. Direct visualization of the small intestine has not been possible until recently with the introduction of wireless endoscopy. OBJECTIVES OF STUDY: Primary. To assess the effect of diclofenac on the small intestine using wireless endoscopy and measurement of calprotectin in the stools. Secondary. To assess the possible effect of diclofenac on gastro-intestinal symptoms and on the level of hemoglobin. METHODS: Twenty healthy volunteers 21-61 years of age, 10 males and 10 women, received diclofenac 75 mg twice daily for 14 days. Wireless endoscopy was performed before and after diclofenac and also measurements of calprotectin in the stools. The volunteers kept a diary of gastro-intestinal related symptoms during the treatment. In order to eliminate injury and symptoms from the stomach and duodenum, omeprazole 20 mg twice daily was given with the diclofenac. RESULTS: Wireless endoscopy before diclofenac showed no abnormalities in the 20 volunteers. After diclofenac treatment wireless endoscopy showed injuries in 14 volunteers but six had no injury. The number of small intestinal injuries found in each volunteer varied from 2-30. The injuries were equally distributed throughout the small intestine. Two volunteers had an injury in the caecum (ulcer, free blood). Stool calprotectin (normal value <60 mg/L) before diclofenac was 29 mg/L (+/-28) but increased to 148 mg/L (+/-108) (p<0.01) after diclofenac. Fourteen volunteers had gastro-intestinal related symptoms. The mean Hemoglobin concentration decreased from 145.1 to 136.8 g/L (p<0.05) with diclofenac treatment. CONCLUSIONS: The administration of diclofenac is associated with injuries in the small intestine similar as have been described in the stomach and duodenum. The symptoms associated with diclofenac in this study could be related to the small intestinal injury.