Does Long-Term Use of Enteric-Coated Diclofenac Cause Intestinal Ulcers? - Gastroenterology and Hepatology

More Info

---

Long-term use of enteric-coated diclofenac, particularly in patients with conditions such as ankylosing spondylitis or other inflammatory disorders, raises important considerations regarding gastrointestinal health. Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that is commonly used to manage pain and inflammation. While enteric-coated formulations are designed to protect the stomach lining by allowing the medication to dissolve in the intestines rather than the stomach, they are not without risks, especially with prolonged use.


Potential Risks of Long-Term Diclofenac Use
1. Gastrointestinal Ulcers: Although enteric-coated diclofenac is less likely to cause gastric ulcers compared to non-coated forms, it can still contribute to intestinal ulcers, particularly in the small intestine and colon. NSAIDs, including diclofenac, can disrupt the mucosal barrier and inhibit the production of protective prostaglandins, leading to mucosal injury. This risk is compounded in patients who have pre-existing gastrointestinal conditions or those who take other medications that may irritate the gastrointestinal tract.

2. Risk Factors for Ulcer Development: The risk of developing ulcers increases with factors such as:
- Long Duration of Use: Prolonged exposure to NSAIDs can lead to cumulative damage to the intestinal lining.

- Concurrent Medications: The use of other medications, particularly corticosteroids or anticoagulants, can increase the risk of gastrointestinal complications.

- Underlying Conditions: Patients with a history of peptic ulcers, inflammatory bowel disease, or other gastrointestinal disorders are at higher risk.

3. Symptoms to Monitor: Patients on long-term diclofenac therapy should be vigilant for symptoms of gastrointestinal distress, including:
- Abdominal pain or discomfort
- Changes in bowel habits (diarrhea or constipation)
- Blood in stool or black, tarry stools
- Unexplained weight loss

Recommendations for Safe Use
1. Co-administration of Proton Pump Inhibitors (PPIs): As mentioned in your question, taking a PPI like pantoprazole (耐適恩錠) after diclofenac can help mitigate the risk of gastrointestinal damage. PPIs reduce gastric acid production, providing a protective effect on the gastric and possibly intestinal mucosa.

2. Regular Monitoring: Patients on long-term NSAID therapy should undergo regular gastrointestinal evaluations, including endoscopy if indicated, to monitor for the development of ulcers or other complications.

3. Alternative Therapies: If there is a concern about gastrointestinal safety, discussing alternative pain management strategies with a healthcare provider is advisable. This may include the use of COX-2 selective inhibitors, which are designed to minimize gastrointestinal side effects, although they also carry their own risks, such as cardiovascular events.

4. Lifestyle Modifications: Incorporating dietary changes, increasing fluid intake, and ensuring adequate fiber in the diet can help maintain gastrointestinal health and mitigate some side effects associated with NSAID use.


Conclusion
In summary, while enteric-coated diclofenac may reduce the risk of gastric ulcers compared to non-coated formulations, it is still associated with the potential for intestinal ulcers, particularly with long-term use. Patients should be aware of the risks and take preventive measures, including the use of PPIs and regular monitoring. It is essential to maintain open communication with healthcare providers to ensure safe and effective management of pain and inflammation while minimizing gastrointestinal risks.