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Drug-Induced Small Bowel Injury: a Challenging and Often Forgotten Clinical Condition

  • Small Intestine (D Sachar, Section Editor)
  • Published:
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Abstract

Purpose of Review

Most drugs are given by the oral route. Oral intake allows direct contact between the drug and the entire GI tract mucosa, exposing it to potential topical damage until absorption. Medication-induced GI symptoms and lesions are therefore commonly encountered in clinical practice. This review will examine the most common drugs or classes of drugs affecting small bowel function and/or structure.

Recent Findings

Since non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medicines, NSAID enteropathy is highly prevalent and brings about considerable morbidity. Antimicrobials and proton-pump inhibitors profoundly modify intestinal microbiota, affecting gut sensory and motor functions, while other drugs (like iron and gold derivatives) impair intestinal permeability. Olmesartan (and likely ACE inhibitors) induce villous atrophy and consequent malabsorption. Mycophenolate mofetil, cancer chemotherapeutic agents, and immune checkpoint inhibitors cause intestinal inflammation, abdominal pain, and diarrhea. Potassium chloride supplements may induce small bowel ulceration, stenosis, and perforation while the cotraceptive pill and anticoagulants are associated with intestinal ischemia and spontaneous intramural hematoma, respectively.

Summary

In clinical practice, a deep knowledge of clinical pharmacology and toxicology and a high degree of suspicion of drug-related adverse events are mandatory. Only then, the practicing physician will be able to diagnose medication-induced small bowel lesions correctly and will implement the best strategies to treat them.

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Notes

  1. An adverse drug event is defined by the World Health Organization as “a response to a drug which is noxious and unintended, and which occurs at doses normally used” (https://apps. who.int/medicinedocs/en/d/Jh2992e/2.html).

  2. NLRP3 = nucleotide-binding oligomerization domain leucine-rich repeat and pyrin domain–containing protein 3

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Authors and Affiliations

  1. LUdeS Lugano Campus, Lugano, Switzerland

    Carmelo Scarpignato

  2. United Campus of Malta, Gzira, Malta

    Carmelo Scarpignato

  3. Faculty of Medicine, Chinese University of Hong Kong, ShaTin, Hong Kong

    Carmelo Scarpignato

  4. Department of Medicine & Surgery, University of Parma, Parma, Italy

    Carmelo Scarpignato

  5. Department of Gastroenterology, King’s College Hospital, London, UK

    Ingvar Bjarnason

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Ingvar Bjarnason declares no conflict of interest.

Carmelo Scarpignato has served as a speaker, consultant, and/or advisory board member for Alfasigma, Pfizer, Takeda, Reckitt Benckiser, and Shionogi and has in the past received funding from Giuliani Pharmaceuticals and Pfizer.

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Scarpignato, C., Bjarnason, I. Drug-Induced Small Bowel Injury: a Challenging and Often Forgotten Clinical Condition. Curr Gastroenterol Rep 21, 55 (2019). https://doi.org/10.1007/s11894-019-0726-1

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