Zhao NH, Zhao LR, Yao J, Niu LY, Yang LJ, Lin YJ, Liu M. Development and validation of a risk prediction model for small intestinal mucosal injury in nonsteroidal anti-inflammatory drug users. World J Gastrointest Surg 2026; 18(2): 115830 [DOI: 10.4240/wjgs.v18.i2.115830]
Corresponding Author of This Article
Mei Liu, Professor, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 430030, Hubei Province, China. fliumei@126.com
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Gastroenterology & Hepatology
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Retrospective Study
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Feb 27, 2026 (publication date) through Feb 26, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Zhao NH, Zhao LR, Yao J, Niu LY, Yang LJ, Lin YJ, Liu M. Development and validation of a risk prediction model for small intestinal mucosal injury in nonsteroidal anti-inflammatory drug users. World J Gastrointest Surg 2026; 18(2): 115830 [DOI: 10.4240/wjgs.v18.i2.115830]
World J Gastrointest Surg. Feb 27, 2026; 18(2): 115830 Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.115830
Development and validation of a risk prediction model for small intestinal mucosal injury in nonsteroidal anti-inflammatory drug users
Ning-Hui Zhao, Ling-Ran Zhao, Jia Yao, Ling-Yun Niu, Long-Jun Yang, Yu-Jia Lin, Mei Liu
Ning-Hui Zhao, Ling-Ran Zhao, Long-Jun Yang, Yu-Jia Lin, Mei Liu, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Ning-Hui Zhao, Jia Yao, Ling-Yun Niu, Department of Gastroenterology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
Author contributions: Zhao NH and Zhao LR wrote the manuscript; Yao J and Niu LY analyzed and interpreted the data; Yang LJ and Lin YJ collected the data; Yao J and Liu M provided financial support; Liu M made critical revisions; and all authors have read and approve the final manuscript.
Supported by the General Program of the National Natural Science Foundation of China, No. 82472961; the Key Research and Development Projects of Hubei Province, China, No. SCZ202111; and Research and Innovation Team Project for Scientific Breakthroughs at Shanxi Bethune Hospital, No. 2024ZHANCHI06.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, approval No. 2024-S079.
Informed consent statement: The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology agreed to waive the patient’s informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Mei Liu, Professor, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 430030, Hubei Province, China. fliumei@126.com
Received: October 27, 2025 Revised: November 27, 2025 Accepted: January 7, 2026 Published online: February 27, 2026 Processing time: 122 Days and 21.5 Hours
Abstract
BACKGROUND
Despite the enhanced detection capability of capsule endoscopy for small intestinal lesions, the independent risk factors and distinct clinical-endoscopic characteristics in high-risk populations remain incompletely elucidated.
AIM
To investigate the risk factors for small intestinal mucosal injury (SIMI) in nonsteroidal anti-inflammatory drug (NSAID) users and to establish a corresponding predictive model.
METHODS
We conducted a retrospective analysis of clinical data from patients undergoing capsule endoscopy at our institution and Shanxi Bethune Hospital from August 2012 to January 2025. Multivariate analysis was performed to identify independent risk factors for SIMI. A nomogram was subsequently developed to predict the risk of SIMI in NSAID users. Receiver operating characteristic curve analysis, calibration curve and decision curve analysis were performed to evaluate the predictive accuracy of the nomogram.
RESULTS
In the primary cohort, SIMI was identified in 114 out of 181 NSAID users. Multivariate analysis revealed that advanced age, smoking, proton pump inhibitor use, elevated body mass index, high triglyceride levels, and increased low-density lipoprotein were independent risk factors for SIMI. The research team developed a risk prediction model for estimating the risk of mucosal injury, which achieved an area under the curve of 0.775 (95% confidence interval: 0.700-0.849) in the derivation set. The model exhibited an area under the curve of 0.797 (95% confidence interval: 0.643-0.952) in the validation cohort.
CONCLUSION
We identified risk factors for SIMI in NSAID users and established a predictive model, which may facilitate early identification of high-risk populations and guide clinical interventions.
Core Tip: This study identified advanced age, smoking, proton pump inhibitor use, elevated body mass index, high triglyceride, and low-density lipoprotein levels as independent risk factors for small intestinal mucosal injury in nonsteroidal anti-inflammatory drug users. A predictive nomogram was developed based on these factors. The model demonstrated good predictive accuracy, with an area under the curve of 0.775 in the derivation cohort and 0.797 in the validation cohort. This tool can facilitate early identification of high-risk individuals and guide clinical interventions to prevent small intestinal mucosal injury.
