Beware NSAID-Induced Lower GI Bleeding

It is well established that nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk for upper gastrointestinal bleeding (UGIB), which can be prevented using proton-pump inhibitors (PPIs). In a commentary in Clinical Gastroenterology and Hepatology, Dr. Francis Chan reminds readers that NSAIDs can also cause lower gastrointestinal bleeding (LGIB).

We know that NSAIDs increase the permeability of the gut and cause blood loss that ranges from clinically insignificant to major. Dr. Chan points out that small bowel lesions are commonly seen by capsule endoscopy in patients using NSAIDs. Most importantly, some data suggest that the use of PPIs actually increases rather than decreases the risk for LGIB. The mechanism may be this: Increased …