High prevalence of NSAID enteropathy as shown by a simple faecal test

• Published in: Gut 1999-09, Vol.45 (3), p.362-366
• Main Authors: Tibble, J A, Sigthorsson, G, Foster, R, Scott, D, Fagerhol, M K, Roseth, A, Bjarnason, I
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Arthritis - drug therapy; Biological and medical sciences; Biomarkers - analysis; Calcium-Binding Proteins - analysis; calprotectin; Confidence intervals; Crohn's disease; Digestive system; Drug dosages; Drug toxicity and drugs side effects treatment; enteropathy; Feces - chemistry; Female; Humans; Indium Radioisotopes; Inflammation; Inflammatory bowel disease; Intestinal Diseases - chemically induced; Intestinal Diseases - diagnosis; Investigative techniques, diagnostic techniques (general aspects); Leukocyte L1 Antigen Complex; Male; Medical sciences; Membrane Glycoproteins - analysis; Middle Aged; Neural Cell Adhesion Molecules - analysis; Neutrophils; Neutrophils - diagnostic imaging; non-steroidal anti-inflammatory drug; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patients; Pharmacology. Drug treatments; Proteins; Radionuclide Imaging; Reproducibility of Results; Small intestine; Statistical analysis; Studies; Toxicity: digestive system
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.45.3.362

BACKGROUND The diagnosis of non-steroidal anti-inflammatory drug (NSAID) induced enteropathy is difficult, requiring enteroscopy or the use of four day faecal excretion of 111In labelled white cells. AIMS To assess faecal calprotectin (a non-degraded neutrophil cytosolic protein) as a method for diagnosing NSAID enteropathy. METHODS Single stool faecal calprotectin concentrations were compared with the four day faecal excretion of 111In labelled white cells in 47 patients taking NSAIDs. The prevalence and severity of NSAID enteropathy was assessed using this method in 312 patients (192 with rheumatoid arthritis, 65 with osteoarthritis, 55 with other conditions) taking 18 different NSAIDs. RESULTS The four day faecal excretion of 111In white cells correlated significantly with faecal calprotectin concentrations. In the group of 312 patients on NSAIDs faecal calprotectin concentrations were significantly higher than in controls, the prevalence of NSAID enteropathy being 44%. The prevalence and severity of NSAID enteropathy was independent of the particular type or dose of NSAID being taken or other patient variables. CONCLUSIONS Assay of faecal calprotectin provides a simple practical method for diagnosing NSAID enteropathy in man. Forty four per cent of patients receiving these drugs had NSAID induced enteropathy when assessed by this technique; 20% of these had comparable levels of inflammation to that previously reported in patients with inflammatory bowel disease.