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Small intestinal mucosal injury is common with Cyclooxygenase inhibitors / Nonsteroidal anti-inflammatory drugs (NSAIDs). The exact mechanisms are unclear. Topical effects are suspected. Many NSAIDs, like diclofenac (DCF), turn into acyl glucuronides (AGs). They are also metabolized into ether glucuronides. These are exported into the biliary tree. In the gut, bacterial beta-glucuronidase cleaves these conjugates. This releases harmful aglycone.
Highly selective inhibition of luminal [bacterial beta-D-glucuronidase](brain:…