Diaphragm disease

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ALgirl
Regular Member


Date Joined Mar 2010
Total Posts : 105
   Posted 3/16/2010 2:09 PM (GMT -7)   
Has anyone ever heard of this??  I was researching types of intestinal strictures/obstructions and came across this.  It is caused by taking NSAIDs (anti-inflammatory drugs like for arthritis, etc).  It causes strictures in the intestines called diaphragms.  I started on indomethacin several months ago for a rare migraine disorder named hemicrania continua.  It was wonderful! Before this medication I had a headache 24/7 that would intensify suddenly and could be bad especially if I was driving and even woke me from a deep sleep.  When I saw the GI he thought I had Crohn's that was flared by the indomethacin so told me not to take it anymore.  Now of course I am back to the 24/7 headache. I am wondering if I might actually have diaphragm disease since the meds for Crohn's are not helping and I just keep feeling worse, and the fact that before going on the med I never had Crohn's symptoms.  I did have a diagnosis of IBS in my early 20's though.   I did look up side effects of indomethacin on drugs.com and intestinal strictures was listed as a rare side effect.  Just looking for some opinions!

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 3/17/2010 6:50 AM (GMT -7)   
Sorry I have never heard of this. When you got diagnosed with Crohns did they do biopsies? If so, and you were diagnosed based on those biopsies, then you have Crohns. Sorry about the headaches, those are so miserable. Hugs!
Gail*Nanners* Co-Moderator for Crohns Disease & Anxiety/Panic
Crohn's Disease for over 34 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 3/17/2010 8:43 AM (GMT -7)   
Gut. 1992 October; 33(10): 1424–1426. Non-steroidal anti-inflammatory drug-induced jejunal and colonic diaphragm disease: a report of two cases.
" ... The jejunum was affected in one, and in the other the ascending colon. Most previously reported cases have shown ileal disease and no case to date has shown involvement of the colon. ..."

•Lang J, Price AB, Levi AJ, Burke M, Gumpel JM, Bjarnason I. Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. J Clin Pathol. 1988 May;41(5):516–526. [PubMed]
•Sturges HF, Krone CL. Ulceration and stricture of the jejunum in a patient on long-term indomethacin therapy. Am J Gastroenterol. 1973 Feb;59(2):162–169. [PubMed]
•Bjarnason I, Price AB, Zanelli G, Smethurst P, Burke M, Gumpel JM, Levi AJ. Clinicopathological features of nonsteroidal antiinflammatory drug-induced small intestinal strictures. Gastroenterology. 1988 Apr;94(4):1070–1074. [PubMed]
•Uribe A, Johansson C, Slezak P, Rubio C. Ulcerations of the colon associated with naproxen and acetylsalicylic acid treatment. Gastrointest Endosc. 1986 Jun;32(3):242–244. [PubMed]
•Aabakken L, Osnes M. Non-steroidal anti-inflammatory drug-induced disease in the distal ileum and large bowel. Scand J Gastroenterol Suppl. 1989;163:48–55. [PubMed]

To more recently:

Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy: endoscopic features of the lesions and endoscopic treatments for diaphragm disease.

Hayashi Y, Yamamoto H, Taguchi H, Sunada K, Miyata T, Yano T, Arashiro M, Sugano K.
J Gastroenterol. 2009;44 Suppl 19:57-63. Epub 2009 Jan 16.
PMID: 19148795 [PubMed - indexed for MEDLINE]

Thank you for bringing this to our attention, ALGirl. I'm so sorry you've run into and are now suffering w/those horrible migranes again.

My family doctor just recently gave me a script for a new NSAID called Zipsor (at least its the first I ever heard of it). I only took it for two days and then encountered just "iffy" enough gut symptoms and just enough pain relief that I then backed off and Tylenol Rapid Release was able to take over and finish the pain relief. (Thank goodness!).

I was given Toradol IV once and was REALLY upset w/the scripting ER doctor since he was aware I had Crohn's once I found out it was an NSAID. It worked WONDERFULLY and it didn't cause any gut problems BUT it was administered improperly, not diluted enough and instead of being administered in a high port near the IV bag was administered in the first port at the IV set in my hand. I ended up w/4 superficial thrombophlebitis lumps along my wrist and forearm - and a blood clot in my axillary vein (just above the heart) and on blood thinners for 6 months.
My computer says I need to upgrade my brain to be compatible with its new software.


ALgirl
Regular Member


Date Joined Mar 2010
Total Posts : 105
   Posted 3/17/2010 9:52 AM (GMT -7)   
Thanks you guys!
 
Nanners, the doc did 30+ biopsies and if I remember correctly he said the result was just "inflammation".  I am going to ask him about this again this afternoon when I see him.
 
ChronieToo, that is an awful experience you had with the Toradol!  When I went for my colonoscopy the nurse that was putting my IV in, etc, said that I shouldn't take NSAIDs because they will "eat a hole in your stomach" and then said that her doctor gave her a prescription for Toradol tablets for her migraines!  I did not know it was an NSAID too!!!
 
 

CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 3/17/2010 2:38 PM (GMT -7)   
Yep, I've learned to NOT fill a prescription for a drug I've never taken before until I talk to the pharmacist or look it up in The Pill Book or online. They almost all have some scarey possible side effects so I just look for the most common ones and then when possible check the %s of people who encountered those side effects during the clinical trials, etc. 10 out of a 1000 isn't as scarey as 10 out of 100, etc.
My computer says I need to upgrade my brain to be compatible with its new software.


CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 3/17/2010 2:59 PM (GMT -7)   
Toradol (ketor0lac, trimethamine) is the newest "darling" of the ER and hospital doctors in our area since it now has a generic available. Its as effective as morphine, longer acting w/less undesirable side effects and its not an opiate or whatever.

"Ketorolac is a member of a class of drugs called nonsteroidal antiinflammatory drugs (NSAIDs) that is used for treating inflammation and pain. Other drugs in this class include ibuprofen (Motrin) and naproxen (Naprosyn, Aleve), but ketorolac is more effective than other NSAIDs in reducing pain from both inflammatory and non-inflammatory causes. Ketorolac reduces the production of prostaglandins, chemicals that cells of the immune system make that cause the redness, fever, and pain of inflammation and that also are believed to be important in the production of non-inflammatory pain. It does this by blocking the enzymes that cells use to make prostaglandins (cyclooxygenase 1 and 2). As a result, pain as well as inflammation and its signs and symptoms - redness, swelling, fever, and pain - are reduced. The FDA approved ketorolac in November 1989."
My computer says I need to upgrade my brain to be compatible with its new software.


ALgirl
Regular Member


Date Joined Mar 2010
Total Posts : 105
   Posted 3/17/2010 5:53 PM (GMT -7)   
Well I talked to my GI and he does not think I have diaphragm disease but still a diagnosis of Crohn's.  I asked what my sed rate was and he said it was 40 and the normal is 20. 
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