Dr. Annette Fritscher-Ravens and colleagues at the University College London have successfully tested in humans a small swallowable gut camera that can be steered around in the gut.

Fritscher-Ravens and her colleagues say they have patented just such a method. Using technology very similar to that found in TV remotes or electronic car-keys, they attached tiny electrodes to the front and rear portions of the video capsule, along with a tiny antenna. Using a drive/reverse switch, they have been able to steer and propel the capsule through the gut, lingering wherever a lesion or other suspicious formation occurs

Passive camera pills known as capsule endoscopes are already available and in clinical and research use. But this new design allows doctors to tell the camera pill to move itself to areas of interest.

An existing passive capsule endoscope was recently used to discover greater side-effects from NSAIDs on the small intestine than had previously been reported.

The capsule endoscope, developed by Given Imaging, allows medical professionals to view the entire small intestine. The system uses a disposable miniature video camera contained in a capsule, which the patient swallows. The capsule passes through the digestive tract, transmitting color images, without interfering with the patient's normal activities. Capsule endoscopy diagnoses a range of diseases of the small intestine including Crohn's Disease, Celiac disease, benign and malignant tumors of the small intestine, vascular disorders, medication related small bowel injury and pediatric small bowel disorders.

The study enrolled 40 patients, with a mean age of 49.5, who had arthritis including osteoarthritis, rheumatoid arthritis and gout. Twenty patients took NSAIDS daily for three months. Twenty patients took acetaminophen alone or nothing at all. All patients fasted overnight and underwent capsule endoscopy. The pylorus, the sphincter muscle that controls the lower opening of the stomach where it empties into the upper part of the small intestine, was marked on each video. Two investigators who were not told which therapy the participants received, reviewed each video beginning after the pylorus, where the small intestine starts.

Severe injury to the small bowel was seen in 23 percent of NSAID users compared to no severe injury in the controls. Severe damage was associated with high doses of indomethacin, naproxen, oxyprozocin and ibuprofen.

Given the widespread long term use of NSAIDs this is an important result. A repeat of this study with a larger variety of NSAIDs and more test subjects could provide useful guidance in NSAID selection.

Update: this latest finding using a camera capsule to see the effects of NSAIDs on the intestines should not be surprising in retrospect. A 1999 study on mice found NSAIDs might be contributing to the development of inflammatory bowel disease.

A question raised by these experiments is the possible role of nonsteroidal anti-inflammatory drugs (NSAIDs) in promoting inflammatory bowel disease. In the researchers' mice, COX-2 inhibition by NSAIDs produced histologic changes reminiscent of human celiac disease. In view of the megaquantities of NSAIDs consumed worldwide, we'll need to delve more deeply into the full effects of COX-2 inhibition on immune homeostasis