Underestimation of clinical importance of non-steroidal anti-inflammatory drug induced enteropathy and its exacerbation by proton pump inhibitors

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used over-the-counter to relieve pain and symptoms of arthritis and soft tissue inflammation. Proton pump inhibitors (PPIs) are often used simultaneously with NSAID to protect against its gastroduodenal side effects. However, the suppression of gastric acid secretion by PPIs does not seem to protect against the damage caused by NSAIDs in the more distal small intestine, often called as NSAID induced enteropathy. In fact, the small intestine seems to be more susceptible to the damaging effects of NSAIDs than the stomach1 and PPI may even exacerbate the NSAID induced enteropathy.2