HISTORY AND PHYSICAL EXAMINATION:A 67-year-old woman was admitted to our hospital for spasmodic abdominal pain, diarrhea, and general weakness. She had lost 5 kg of weight over the past few weeks. The patient had a 20-year history of chronic analgetic abuse, mainly consuming over-the-counter nonsteroidal anti-inflammatory drugs (NSAID). EXAMINATION:Laboratory examination was remarkable for a low serum albumin (2.3 g/dl), an increased erythrocyte sedimentation rate of 70 mm/h, and a profound anemia of 8.5 g/dl. Ultrasound of the abdomen showed thickening of the colonic wall and distended colon loops filled with fluid. On colonoscopy several ulcerations from the sigmoid to the ileum were seen. Histologic examination showed a nonspecific ileocolitis. DIAGNOSIS, THERAPY AND CLINICAL COURSE:After cessation of NSAID intake diarrhea stopped within a few days. Abdominal pain resolved, anemia improved and the patient gained weight. A second colonoscopy revealed healing of the colonic ulcerations. Additional examinations regarding differential diagnoses showed no pathological results. Clinical course and subsequent clinical and endoscopic controls revealing further improvement confirmed the diagnosis of an NSAID-induced ileocolitis. CONCLUSION:This patient is a typical example for NSAID-induced colonic ulcerations. It should be recognized that NSAID induce ulcers not only in the upper gastrointestinal tract. A careful drug history may provide the clue for the cause of lower gastrointestinal tract ulcerations.

译文

历史和体格检查:一名67岁的妇女因痉挛性腹痛,腹泻和全身无力而入院。在过去的几周里,她的体重减轻了5公斤。该患者有20年的慢性镇痛药使用史,主要服用非处方类固醇抗炎药(NSAID)。
检查:实验室检查显着,血清白蛋白低(2.3 g / dl),红细胞沉降速率增加70 mm / h,深度贫血8.5 g / dl。腹部超声检查显示结肠壁增厚,结肠环充满液体。在结肠镜检查中,发现从乙状结肠到回肠有数个溃疡。组织学检查显示为非特异性回肠结肠炎。
诊断,治疗和临床过程:停止服用非甾体抗炎药后几天内腹泻就停止了。腹痛缓解,贫血得到改善,患者体重增加。第二次结肠镜检查显示结肠溃疡的愈合。有关鉴别诊断的其他检查未显示病理结果。临床过程以及随后的临床和内窥镜检查对照显示出进一步的改善,证实了NSAID诱发的回肠结肠炎的诊断。
结论:该患者是NSAID引起的结肠溃疡的典型例子。应该认识到,NSAID不仅在上消化道诱发溃疡。仔细的服药史可能为下消化道溃疡的病因提供线索。

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