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Drug-induced enteropathy

Michael A Mancano
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MED WATCH program (800-FDA-1088). If you have reported an interesting, preventable ADR to MED WATCH, please consider sharing the account with our readers. Write to Dr. Mancano at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-707-4936; e-mail: Your report will be published anonymously unless otherwise requested...
November 2015: Hospital Pharmacy
Yasuaki Ueno, Masanao Nakamura, Osamu Watanabe, Takeshi Yamamura, Kohei Funasaka, Eizaburo Ohno, Ryoji Miyahara, Hiroki Kawashima, Hidemi Goto, Yoshiki Hirooka
The patient was a 72 year old man who had been given non-steroidal anti-inflammatory drug (NSAID) for two years. He repeatedly developed small intestinal ileus; therefore, he underwent several imaging examinations, but the cause was not identified. He subsequently underwent a double-balloon endoscopy (DBE). The membranous stenoses were detected in the jejunum, and the biopsy specimens were taken during the DBE. The membranous stenoses in the gastrointestinal tract were characteristic of NSAID-induced enteropathy, and he was endoscopically and histopathologically diagnosed with NSAID-induced small intestinal disorder...
August 2016: Nagoya Journal of Medical Science
Ilja Tachecí, Petr Bradna, Tomáš Douda, Drahomíra Baštecká, Marcela Kopáčová, Stanislav Rejchrt, Martin Lutonský, Tomáš Soukup, Jan Bureš
: The goal of this prospective study was to assess non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) by means of non-invasive wireless capsule enteroscopy. A total of 143 patients (74 with RA, 69 with OA) treated with NSAIDs (>1 month) and 42 healthy volunteers were included. All subjects underwent capsule endoscopy, laboratory tests and filled in questionnaires. The severity of small bowel injury was graded as: mild (red spots or sporadic erosions), moderate (10-20 erosions) or severe (>20 erosions or ulcers)...
November 2016: Rheumatology International
Keiichi Uchida, Atsushi Nakajima, Kosuke Ushijima, Shinobu Ida, Yoshitaka Seki, Fumihiko Kakuta, Daiki Abukawa, Hisayuki Tsukahara, Shun-Ichi Maisawa, Mikihiro Inoue, Toshimitsu Araki, Junji Umeno, Takayuki Matsumoto, Tomoaki Taguchi
We performed a Japanese nationwide survey of pediatric-onset chronic nonspecific multiple ulcers of the small intestine between January 2000 and July 2013 in 176 institutions of pediatric surgery or pediatric gastroenterology and clarified the clinical features associated with genetic abnormalities in the Solute Carrier Organic Anion Transporter Family, Member 2A1 (SLCO2A1) gene. A total of four cases (three female and one male) were diagnosed in this series, which had to be differentiated from Crohn disease, Behçet's disease, tuberculosis, or drug-induced enteropathy...
June 21, 2016: Journal of Pediatric Gastroenterology and Nutrition
Claudine Desruisseaux, Michaël Bensoussan, Etienne Désilets, Hanh-Khiem Tran, Robert Arcand, Germain Poirier, Andrew Wisniewski, Thibaut Manière
Collagenous sprue (CS) is a distinct clinicopathological disorder histologically defined by a thickened subepithelial band (Freeman, 2011). It is a rare condition which has been recently observed in a significant proportion of sprue-like enteropathy associated with olmesartan, a novel entity described by Rubio-Tapia et al. in 2012. CS is historically associated with a poor prognosis (Marthey et al., 2014). However, histological and clinical improvements have been described in most studies with concomitant usage of corticosteroids and/or gluten-free diet (Marthey et al...
2016: Canadian Journal of Gastroenterology & Hepatology
Moira Paroni, Andrea Magarotto, Silvia Tartari, Giulia Nizzoli, Paola Larghi, Giulia Ercoli, Umberto Gianelli, Massimiliano Pagani, Luca Elli, Sergio Abrignani, Dario Conte, Jens Geginat, Flavio Caprioli
OBJECTIVES: To provide a functional and phenotypic characterization of immune cells infiltrating small intestinal mucosa during non-IPEX autoimmune enteropathy (AIE), as to gain insights on the pathogenesis of this clinical condition. METHODS: Duodenal biopsies from a patient with AIE at baseline and following drug-induced remission were analyzed by immunohistochemistry, immunofluorescence, and flow cytometry, and results were compared with those obtained from patients with active celiac disease, ileal Crohn's disease and healthy controls...
2016: Clinical and Translational Gastroenterology
Ying Mei, Zhaozhao Xiao, Jinwu Feng, Ting Wang, Changcheng Zhang, Ding Yuan, Chaoqi Liu
Objective To investigate the preventive effect of total saponins of Panax japonicus (SPJ) on nonsteroidal anti-inflammatory drug (NSAID)-induced intestinal injuries in mice. Methods NSAID-induced intestinal mucosal damaged models were established by intragastric administration of 5 mg/mL diclofenac sodium in mice for continuous 2 days. Since 4 days before the modeling, the mice in the experimental group were given SPJ once a day for 6 days. The small intestinal mucosal permeability was detected by fluorescein isothiocyanate-dextran (FITC-DT) and Evans blue staining...
June 2016: Xi Bao Yu Fen Zi Mian Yi Xue za Zhi, Chinese Journal of Cellular and Molecular Immunology
Ze-Yu Zhong, Bin-Bin Sun, Nan Shu, Qiu-Shi Xie, Xian-Ge Tang, Zhao-Li Ling, Fan Wang, Kai-Jing Zhao, Ping Xu, Mian Zhang, Ying Li, Yang Chen, Li Liu, Lun-Zhu Xia, Xiao-Dong Liu
AIM: Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), which may cause serious intestinal adverse reactions (enteropathy). In this study we investigated whether co-administration of ciprofloxacin affected the pharmacokinetics of diclofenac and diclofenac-induced enteropathy in rats. METHODS: The pharmacokinetics of diclofenac was assessed in rats after receiving diclofenac (10 mg/kg, ig, or 5 mg/kg, iv), with or without ciprofloxacin (20 mg/kg, ig) co-administered...
July 2016: Acta Pharmacologica Sinica
Nassim Hammoudi, Marie Dior, Vincent Giraud, Benoit Coffin
Olmesartan is an angiotensin II receptor antagonist which may cause severe sprue-like enteropathy with duodenal villous atrophy. Skin lesions may be associated as reported for the first time in our case. Clinicians should be informed of this side effect and its reversibility after suspension of the drug.
April 2016: Clinical Case Reports
Devendra Pratap Singh, Swapnil P Borse, Manish Nivsarkar
The pathogenesis of nonsteroidal anti-inflammatory drug (NSAID) enteropathy is still unclear, and consequently, there is no approved therapeutic strategy for ameliorating such damage. On the other hand, molecular treatment strategies targeting tumor necrosis factor (TNF) exerts beneficial effects on NSAID-induced intestinal lesions in rodents and rheumatoid arthritis patients. Thus, TNF appears to be a potential therapeutic target for both the prevention and treatment of NSAID enteropathy. However, the causative relationship between TNF and NSAID enteropathy is largely unknown...
September 2016: Translational Research: the Journal of Laboratory and Clinical Medicine
Kenichi Yoshikawa, Chie Kurihara, Hirotaka Furuhashi, Takeshi Takajo, Koji Maruta, Yuichi Yasutake, Hirokazu Sato, Kazuyuki Narimatsu, Yoshikiyo Okada, Masaaki Higashiyama, Chikako Watanabe, Shunsuke Komoto, Kengo Tomita, Shigeaki Nagao, Soichiro Miura, Hisao Tajiri, Ryota Hokari
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular painkillers, but they have serious side effects, not only in the upper gastrointestinal tract but also in the small intestine. It is well known that psychological stress may exacerbate various gastrointestinal diseases. The aim of this study was to determine whether psychological stress exacerbates NSAID enteropathy and to determine the possible underlying mechanisms for this. METHODS: Experiment 1: mice were exposed to water avoidance stress (WAS) or sham stress for 1 h per day for 8 consecutive days, and then enteropathy was induced by indomethacin...
April 13, 2016: Journal of Gastroenterology
Laurens J Ceulemans, Faouzi Braza, Diethard Monbaliu, Ina Jochmans, Gert De Hertogh, Johannie Du Plessis, Marie-Paule Emonds, Hiroaki Kitade, Masaru Kawai, Ying Li, Zhao Xiangdong, Takaaki Koshiba, Ben Sprangers, Sophie Brouard, Mark Waer, Jacques Pirenne
Intestinal transplantation (ITx) remains challenged by frequent/severe rejections and immunosuppression-related complications (infections/malignancies/drug-toxicity). We developed in the lab the Leuven Immunomodulatory Protocol (LIP) and translated it to the clinics. LIP consists in experimentally-proven maneuvers, destined to promote T-regulatory (Tregs)-dependent graft-protective mechanisms: Donor-Specific-Blood-Transfusion (DSBT); avoiding high-dose steroids/calcineurin-inhibitors; minimizing reperfusion-injury and endotoxin-translocation...
April 1, 2016: American Journal of Transplantation
Canaan M Whitfield-Cargile, Noah D Cohen, Robert S Chapkin, Brad R Weeks, Laurie A Davidson, Jennifer S Goldsby, Carrie L Hunt, Shelby H Steinmeyer, Rani Menon, Jan S Suchodolski, Arul Jayaraman, Robert C Alaniz
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most frequently used classes of medications in the world. Unfortunately, NSAIDs induce an enteropathy associated with high morbidity and mortality. Although the pathophysiology of this condition involves the interaction of the gut epithelium, microbiota, and NSAIDs, the precise mechanisms by which microbiota influence NSAID enteropathy are unclear. One possible mechanism is that the microbiota may attenuate the severity of disease by specific metabolite-mediated regulation of host inflammation and injury...
May 3, 2016: Gut Microbes
Francis K L Chan
No abstract text is available yet for this article.
June 2016: Clinical Gastroenterology and Hepatology
Matteo Fornai, Luca Antonioli, Carolina Pellegrini, Rocchina Colucci, Deborah Sacco, Erika Tirotta, Gianfranco Natale, Alessia Bartalucci, Marina Flaibani, Cecilia Renzulli, Emilia Ghelardi, Corrado Blandizzi, Carmelo Scarpignato
Nonsteroidal anti-inflammatory drugs, besides exerting detrimental effects on the upper digestive tract, can also damage the small and large intestine. Although the underlying mechanisms remain unclear, there is evidence that enteric bacteria play a pivotal role. The present study examined the enteroprotective effects of a delayed-release formulation of rifaximin-EIR (R-EIR, 50mg/kg BID, i.g.), a poorly absorbed antibiotic with a broad spectrum of antibacterial activity, in a rat model of enteropathy induced by indomethacin (IND, 1...
February 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Ségolène Toquet, Yohan Nguyen, Adel Sabbagh, Zoubir Djerada, Camille Boulagnon, Firouzé Bani-Sadr
The folic acid antagonist methotrexate is a cornerstone treatment of rheumatoid arthritis. Its use is limited chiefly by gastrointestinal toxicity, which is among the main reasons for methotrexate discontinuation. Here, we report the case of a 40-year-old man on chronic methotrexate therapy in whom life-threatening apoptotic enteropathy with watery diarrhea and hypovolemic shock developed after he was switched from the oral to the intramuscular route, with no change in dosage. Colonic biopsies suggested drug-induced colitis, showing a nonspecific, mildly inflammatory infiltrate of lymphocytes and plasma cells, dilated damaged crypts, and a marked increase in basal crypt apoptosis (>20 apoptotic bodies/100 crypts)...
March 2016: Joint, Bone, Spine: Revue du Rhumatisme
Polychronis Pavlidis, Ingvar Bjarnason
Aspirin is in many ways a non- steroidal anti-inflammatory drug (NSAID) prototype. Similar to conventional NSAIDs the gastric side effects of aspirin are well studied. However its potential adverse effects on the small and large intestine are less well known and under- researched. Experimental studies support a pathogenic pathway leading to NSAID enteropathy involving the topical effects on the intestinal barrier (mucous layer, enterocytes) that lead to dysfunction and increased intestinal permeability followed by increased exposure to luminal triggers and acute inflammation...
2015: Current Pharmaceutical Design
A Higashimori, T Watanabe, Y Nadatani, S Takeda, K Otani, T Tanigawa, H Yamagami, M Shiba, K Tominaga, Y Fujiwara, T Arakawa
Nonsteroidal anti-inflammatory drugs (NSAIDs) induce cytokines, including tumor necrosis factor-α and interleukins (ILs), in the small intestine via a Toll-like receptor 4 (TLR4)-dependent pathway, leading to intestinal ulceration. Activation of the inflammasome promotes pro-caspase-1 cleavage, leading to pro-IL-1β maturation. We examined the role of NLRP3 inflammasome in NSAID-induced enteropathy. Small intestinal damage developed 3 h after indomethacin administration, accompanied by increases in IL-1β and NLRP3 mRNA expression and mature caspase-1 and IL-1β levels...
May 2016: Mucosal Immunology
Momoko Akashi, Takayuki Ando, Takeru Hamashima, Hiroki Yoshita, Sohachi Nanjo, Hiroshi Mihara, Haruka Fujinami, Shinya Kajiura, Jun Nishikawa, Yoshiaki Miura, Ayumu Hosokawa, Toshiro Sugiyama
The diagnosis of NSAID-induced colon ulcers is difficult when the distribution or endoscopic findings are not typical. An 83-year-old woman was transferred to our hospital for hemorrhagic diarrhea. Colonoscopy showed multiple ulcers in the entire colon, particularly longitudinal ulcers in the transverse colon. These were unusual for NSAID-induced colopathy, although she had been on meloxicam. However, capsule endoscopy revealed multiple scars and erosions, characteristic of NSAIDs users. The final diagnosis was NSAID-induced enteropathy, and all lesions were in remission after meloxicam discontinuation...
2015: Internal Medicine
P-Y Chang, Y-Q Qu, J Wang, L-H Dong
Although radiotherapy is effective in managing abdominal and pelvic malignant tumors, radiation enteropathy is still unavoidable. This disease severely affects the quality of life of cancer patients due to some refractory lesions, such as intestinal ischemia, mucositis, ulcer, necrosis or even perforation. Current drugs or prevailing therapies are committed to alleviating the symptoms induced by above lesions. But the efficacies achieved by these interventions are still not satisfactory, because the milieus for tissue regeneration are not distinctly improved...
2015: Cell Death & Disease
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