The injurious effects of
NSAIDs on the small intestine were not fully appreciated until the widespread use of
capsule endoscopy. It is estimated that over two-thirds of regular
NSAID users develop injury in the small intestinal
injuries and that these
injuries are more common than gastroduodenal mucosal
injuries. Recently, chronic low-dose
aspirin consumption was found to be associated with injury to the lower gut and to be a significant contributing factor in small bowel ulceration,
hemorrhage, and
strictures. The ability of
aspirin and
NSAIDs to inhibit the activities of
cyclooxygenase (COX) contributes to the cytotoxicity of these drugs in the gastrointestinal tract. However, many studies found that, in the small intestine, COX-independent mechanisms are the main contributors to
NSAID cytotoxicity. Bile and Gram-negative bacteria are important factors in the pathogenesis of
NSAID enteropathy. Here, we focus on a promising strategy to prevent
NSAID-induced small intestine injury. Selective
COX-2 inhibitors,
prostaglandin derivatives, mucoprotective drugs,
phosphatidylcholine-
NSAIDs, and probiotics have potential protective effects on
NSAID enteropathy.