ORIGINAL ARTICLE

Non-specific multiple ulcers of the small intestine unrelated to non-steroidal anti-inflammatory drugs

T Matsumoto¹, M Iida¹, T Matsui², T Yao², H Watanabe⁴, T Yao³, H Okabe⁵

¹ Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
² Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino 818-8502, Japan
³ Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University
⁴ Division of Molecular and Diagnostic Pathology, Department of Molecular Genetics, Course for Molecular and Cellular Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8501, Japan
⁵ Department of Internal Medicine, Kitasato University School of Medicine, Kanagawa 228-8555, Japan

Correspondence to:
Correspondence to:
Dr T Matsumoto
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan; matane{at}intmed2.med.kyushu-u.ac.jp

Aim: Non-steroidal anti-inflammatory drug (NSAID) enteropathy is a cause of chronic blood and protein loss from the intestine. The aim of this investigation was to compare NSAID enteropathy with enteropathy not related to chronic NSAID use.

Patients/Methods: During the period 1967–97, 12 cases of non-specific small intestinal multiple ulcers were laparotomised because of chronic and persistent blood loss for a prolonged period. The clinical features before and after surgery, and the small intestinal lesions, were compared between NSAID users and non-users.

Results: Three patients were NSAID users and the other nine were not. Initial clinical manifestations, haemoglobin concentrations, serum protein values, and inflammatory reactions were similar in the two groups. In both groups there were multicentric stenoses in the small intestine. In those not using NSAIDs, the stenoses were accompanied by multiple, sharply demarcated small ulcers with minimal and non-specific chronic inflammatory infiltrates. The small intestinal ulcers in NSAID users showed linear and circumferential alignment. NSAID users were free from medication during the subsequent period of observation, whereas repeated laparotomy and medication were required in eight of the nine patients not using NSAIDs.

Conclusion: There appears to be a chronic enteropathy, not related to the use of NSAIDs, in which non-specific multiple ulcers are found. This enteropathy may be a distinct entity that causes persistent blood and protein loss from the intestine.

Abbreviations: CMUSE, cryptogenic multifocal ulcerous stenosing enteritis; CRP, Creactive protein; NSAID, non-steroidal anti-inflammatory drugs

Keywords: small intestine; ulcers; stenosis; nonsteroidal antiinflammatory drug

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