Impact of diclofenac use on the incidence and severity of ischemic colitis: A systematic rewiew

Introduction: Ischemic colitis is inflammation of the colon caused by decreased blood flow, being the most frequent form of intestinal ischemia. Symptoms can be mild to severe complications such as intestinal perforation. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), which is commonly used, has been associated with various gastrointestinal complications. Currently, several studies have suggested a possible relationship between diclofenac use and ischemic colitis. Objective: To evaluate the impact of diclofenac use on the incidence and severity of ischemic colitis through a systematic review of the available scientific literature. Materials and Methods: An exhaustive search of databases such as Pudmed and Scielo was performed to identify relevant studies that analyzed the relationship between diclofenac use and ischemic colitis, using the following terms: “Colitis”; “Ischemia”; “Diclofenac”; “Colon”; “Anti-Inflammatory Agents, Non- Steroidal”. Observational studies, clinical trials and case reports were included. Data were extracted and analyzed to assess the incidence and severity of ischemic colitis in patients treated with diclofenac. Results: The articles reviewed indicate a significant relationship between the use of diclofenac and the appearance of ischemic colitis. Bielsa Martín et al. (2006) presented specific cases of acute colitis induced by diclofenac. Gleeson and Davis (2003), together with Sierra Gabarda et al. (2022) found a correlation between the use of NSAIDs and the recent diagnosis of ischemic colitis. The proposed mechanisms involve inhibition of prostaglandin synthesis, which affects intestinal mucosal integrity and blood perfusion Conclusion: This systematic review emphasizes the significant impact of diclofenac on the incidence and severity of ischemic colitis. It is recommended that clinicians cautiously evaluate the need to prescribe diclofenac, considering therapeutic alternatives with less risk and monitoring those patients with risk factors. In addition, further research is needed to confirm a conclusive causal relationship and to develop preventive and therapeutic strategies to help reduce the risks associated with diclofenac use.