Resolution of multiple severe colonic strictures with prednisone therapy: DISCUSSION (Part 1)

Colonic diaphragm formation

Colonic diaphragm formation is a rare and poorly understood side effect of NSAID use that can have serious consequences. Many NSAIDs have been associated with this complication, but most followed the introduction of extended-release NSAIDs and a disproportionate number have occurred with enteric-coated diclofenac preparations. Chronic NSAID-induced colonic ulceration may persist because of antibodies to cyclooxygenase, or the influence of bile acids, bacteria, food antigens or neutrophil chemoattractants. Of the 33 previously published cases in the English literature, the clinical and laboratory features that prompted investigation most often are listed in Table 1. They were most frequent in the right colon (Table 2). The differential diagnosis for the strictures includes Crohn’s disease and colon cancer. You are always welcome to visit the best and most trusted pharmacy offering to buy cheap antibiotics let’s go here and giving you only most efficient medications with no rx required and fast delivery right to your doorstep.

TABLE 1 Symptoms and signs prompting investigation in patients with nonsteroidal anti-inflammatory drug-induced colonic strictures

Symptom or sign Cases (%)
Anemia 20 (61)
Abdominal pain 14 (42)
Diarrhea 8 (24)
Weight loss 6 (18)
Anorexia 4 (12)
Nausea ± vomiting 4 (12)
Constipation 2 (6)
Frank hematochezia 1 (3)
Perforated viscus 1 (3)
Abdominal mass 1 (3)

n = 33

TABLE 2 Locations of nonsteroidal anti-inflammatory drug-induced colonic strictures

Location Cases (%)
Right colon only 26 (79)
Right and transverse colon 4 (12)
Left colon only 1 (3)
Left and transverse colon 1 (3)
Transverse colon only 1 (3)

n = 33

Category: Prednisone therapy

Tags: Anti-inflammatory agents, Colonic diseases, Non-steroidal, Prednisone

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