Paris, France - Taking nonsteroidal anti-inflammatory drugs (NSAIDs) more than doubles the risk of acute diarrhea compared with periods of non-use, according to a new study. The association between NSAIDs and problems like onset of ischemic colitis or the first attack of inflammatory bowel disease has long been recognized, almost always occurring in patients with diarrhea. Since data suggests that NSAIDs do not alter the colon's mucus membrane in patients who do not have diarrhea, Dr. Isabelle Etienney (Hopital Rothschild, Paris) and colleagues studied whether NSAIDs can actually cause acute diarrhea. Results are published in the May 2003 issue of Gut.

"We suggest that acute diarrhea seen in general practice, and not only acute colitis seen by gastroenterologists, should be considered as a potential complication of recent NSAID intake," states Etienney.

Etienney turned to 1000 general practitioners who belong to the French Sentinel network for surveillance of communicable diseases. These doctors provided information on patients' consecutive cases of acute diarrhea that had lasted for one month and were not serious enough to require stool examination. 476 of the 1000 doctors agreed to participate; 269 did not report any cases; 207 reported data for 285 patients between December 1998 and July 1999. Patients had taken 12 different NSAIDs, although Etienney notes that there was no significant association between diarrhea and any particular drug. Written prescriptions for the medications were confirmed from medical records for 73% of patients.

Results
The majority of patients in this study (231 of 285) did not have infectious agents identifiable on stool examination. Yet the diarrhea was much more likely to appear after the patient took NSAIDs. Etienney points out that the cases included in this study were severe, but only 5% of the acute diarrhea cases seen in general practice are serious enough to require stool examination. Clinical diagnosis was based on the presence of fever, clinical dehydration, and/or visible blood in stools.

Given these results, Etienney feels that the use of NSAIDs may trigger the first attack of inflammatory bowel disease or may reactivate preexisting disease. NSAID-induced colitis is a rare but potentially fatal complication, and this study raises the question of a link to NSAID-induced diarrhea.

"Our results suggest that certain cases of severe acute diarrhea, and not only of severe colitis, should be considered as potential direct or indirect complications of recent NSAID intake." Etienney believes that endoscopic studies are needed to help determine whether cases of severe ambulatory NSAID-induced diarrhea are associated with lesions of colitis.