UK Patient Cured of drug induced Diaphragm disease caused by over-usage of pain killers - First such case reported in India

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UK Patient Cured of drug induced Diaphragm disease caused by over-usage of pain killers - First such case reported in India

05th Jul 2014

Mrs. Jasbir Kaur Chahal is a 51 year old lady from London, UK, who presented to us on 18thof June with a history of episodes of intestinal obstruction and abdominal pain. She had been to several centers in the UK for investigations and evaluations and finally chose to come to MIOT International for treatment.

She gave a history of prolonged use of NSAIDs for a condition called ANKYLOSING SPONDYLITIS, which is a condition that affects the spine. The possibility of drug (NSAID) induced DIAGHPRAGM DISEASE, a very rare condition was considered. The patient had been on liquid and low roughage diet for several months in order to avoid intestinal obstruction.


On evaluation, CT enteroclysis and MRI enteroclysis revealed multiple strictures in the distal ileum. In order to confirm the findings and make a definitive diagnosis, it was important to do a “DOUBLE BALLOON ENTEROSCOPY”, which is a difficult procedure involving the use of an enteroscope supported by balloons to slide the enteroscope into the affected portion of the intestine. Dr. Arulprakash, an expert in this procedure, chose the difficult option of going through the colon, past the ileocaecal junction into the small intestine. Multiple areas of stricture were identified and biopsied.

The histopathology showed ulceration and submucosal chronic inflammation.

We consulted our GI surgeons and Prof. Baskaran decided to do a Stricturoplasty or Resection.





During the surgery, Dr. Arulprakash assisted the surgeons by passing an endoscope to the area of involvement. It was evident that the lesion involved was two feet of the small intestine with a nine membrane like strictures. Prof. Baskaran proceeded to resect the involved segment (almost 2 Feet) and anastamosed the uninvolved ends of the bowel.

Mrs. Jasbir Kaur Chahal has had her first full meals nearly after 3 years and she is now well and ready for discharge.


  • In our country there is considerable use and abuse of NSAIDs which are pain killers bought across the counter from Pharmacies. Diaphragm Disease is presents in patients with Chronic NSAID abuse.
  • Diaphragm disease presents with intestinal obstruction. The investigation of choice is enteroscopy, which means visualizing the small intestine using a Double Balloon Enteroscope. This is a technique that needs tremendous skill and dexterity and only an expert in this procedure can skillfully use the double balloon enteroscope to identify the lesion and make a diagnosis.
  • The multi-disciplinary team approach at MIOT International by the GI medical team and GI surgeons, where they did the procedure together in the Operation Theatre, helped in confirming the diagnosis and proceed with surgical resection, which has lead to a cure.
  • This is the first such case reported in India.