Lower Gastrointestinal Bleeding due to Non-Steroid Anti-Inflammatory Drug-Induced Colopathy Case Report and Literature Review
A 43-year-old female, known to have lumbar disc herniation and severe low back pain, was admitted to the hospital because of painless hematochezia, since one day prior to admission. She had no history of abdominal pain, altered bowel habits, fever, anorexia, weight loss or previous gastrointestinal (GI) bleeding.\nCurrent medications were: extended release Alfen-X (oral diclofenac, 100 mg bid), Gabapentine (300 mg qd), Baclofen (10 mg qd) and intermittent usage of ibuprofen and indomethacin, for four months, due to chronic low back pain. On physical exam, the vital signs was stable and she was afebrile. Abdomen was soft, non-tender,and with normal bowel sound.\nLab tests showed white blood cells count of 9.8 x 103/μL, hemoglobin of 9.5 g/dL, and MCV of 79fL,a normochrom-normocytic anemia which was probably due to acute blood loss. ESR, CRP, LFT, Bun and Cr were within normal limits. Colonoscopy revealed multiple ulcers with clot and fibrin exudates on it in the ascending colon, cecum and terminal ileum respectively (,,), and a few small superficial ulcerations in the transverse, descending colon.\nBiopsies from ascending colon, cecum and terminal ileum showed edema, an intense inflammatory cells (lymphocyte and neutrophils) infiltration between glands and ulceration and without evidence of granuloma, fibrosis, crypt abscess, dysplasia and malignancy.(,,)\nBleeding stopped spontaneously one day after admission, and she was discharged four days later without any complications. Additional lab tests were negative for anti-saccharomyces cerevisiae antibody, and anti-neutrophil cytoplasmic antibodies; the stool culture was also negative. According to clinical, endoscopic, pathologic and laboratory data in addition to her history of excessive NSAIDs use, the preferred diagnosis was NSAID-induced colopathy. Alfen-x, ibuprofen and indomethacin were stopped and the patient was followed with a planned colonoscopy, 6-8 weeks later. Two months after discontinuation of NSAIDs, the second colonoscopy showed normal appearing colonic mucosa up to the level of the cecum.(,,). The patient had no GI complaint in serial follow-up.