Nonsteroidal anti-inflammatory drugs-associated colopathy

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used worldwide, and their complications in the upper gastrointestinal tract are well described in the literature and well known to clinicians. However, complications in the large bowel are being increasingly recognized and reported. This review aims to address the different aspects of NSAIDs-associated colopathy. Methods: This is a review article addressing NSAIDs colopathy. A Medline-based search was performed for articles published between 1950 and 2008 on this condition. Keywords detailed were colonic disease, ulcers, strictures and/or diaphragm strictures. Only articles in the English language were considered. Results: The articles identified included letters to the editors, case reports, case series, review articles and few original research papers. The review was structured in a narrative style in different sections addressing pathophysiology, clinical presentation and management. Conclusions: NSAIDs colopathy is a rare benign condition. Current evidence only suggests an association with prolonged use of the NSAIDs, however, there are no studies to support the direct causation. The presentation is non-specific, and the commonest findings on endoscopy are ulceration and diaphragm-like strictures. The importance of identifying this condition is to prevent complications and also to be able to differentiate it from other conditions such as inflammatory bowel disease (IBD) and malignancy.