The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e2 

Iron Deficiency Anemia Secondary to 
Colonic Diaphragm Disease 

David Farrow 1*, Anita Kottapalli1,  Bryanna Jay1, Ajit Ramadugu2, Yaseen Alastal1

1Division of Internal Medicine , Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: david.farrow@utoledo.edu

Published: 05 May 2023 

Introduction: The chronic use of NSAIDs has many well-established effects on the digestive system 
specifically within the upper GI tract. One uncommon complication of chronic NSAID use is the 
formation of diaphragm-like strictures, characterized by the circumferential narrowing of mucosal 
membranes. These diaphragm-like strictures are most encountered in the small intestine, and there exists 
a limited number of cases reporting occurrence of such lesions within the colon. Our case highlights one 
such example and the importance of considering NSAID-induced colopathy as a causative factor for iron 
deficiency anemia. 

Case Report: A 69-year-old female with history of chronic low back pain and associated long-term use 
of  diclofenac 75 mg twice daily (**do we know the dose and for how long**) presented to the hospital 
with a hemoglobin of 6.2 g/dL discovered on outpatient lab work. Addional labs showed  iron saturation  
5% and ferritin 2 ng/ml at that time, consistent with iron deficiency anemia. She endorsed dyspnea on 
exertion, fatigue and lightheadedness for one month duration and denied symptoms of overt GI bleeding. 
The patient had a colonoscopy five years prior to presentation which revealed several benign polyps and 
diverticulosis with no strictures. EGD and colonoscopy were subsequently pursued. EGD showed mild 
erosive gastritis and colonoscopy revealed 5 diaphragm-like strictures with ulcerative edges located in 
the ascending and proximal transverse colon requiring CRE balloon dilation up to 15 mm to allow 
passage of the scope. The ileocecal valve could not be traversed due to significant narrowing. Biopsy of 
the diaphragm lesions showed benign colonic mucosa with chronic architectural distortion and ulcer bed. 
NSAID-induced colopathy was suspected to be the cause of anemia, for which she was counseled to 
discontinue NSAID use.    

Discussion: NSAID-induced diaphragm-like strictures are encountered most often in the small intestine, 
specifically at the ileum. Colonic diaphragm disease (CDD) remains a lesser recognized entity and their 
prevalence remains unknown, occurring predominantly in the proximal ascending colon. Poor 
recognition of NSAID-induced colopathy has led to misdiagnosis with conditions such as Crohn's 
disease. Therefore, in providing another example of this rarer finding, it is one aim of this case report to 

https://dx.doi.org/10.46570/utjms.vol11-2023-663 

https://dx.doi.org/10.46570/utjms.vol11-2023-663
mailto:david.farrow@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-663 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-663 2 ©2023 UTJMS 

encourage NSAID-induced colopathy to be considered in differential diagnosis for iron deficiency 
anemia among different other GI pathologies. 

https://dx.doi.org/10.46570/utjms.vol11-2023-663
https://dx.doi.org/10.46570/utjms.vol11-2023-663