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Colitis pp 169-181 | Cite as

Drug-Induced Colon Injury

  • Louis Libbrecht
  • Anne Jouret-Mourin
  • Karel Geboes
Chapter

Abstract

Drug-induced injury of the colon is a relatively frequent though underestimated event. The histological manifestations are very variable and frequently mimic other disease entities with different etiologies. The pathologist should try to give to the clinician indications concerning a possible drug-related etiology of the injury, with a specification of the drug involved, if feasible. Careful clinicopathological confrontation is important to distinguish drug-related injury from other diseases of the colon. The following section provides an overview of the different patterns that can be encountered in drug-induced colon injury, their relation to specific medications, and the possible differential diagnosis.

Keywords

Colitis Drug-induced Diarrhea Erosions Ulcerations Microscopic colitis Resins IBD-like colitis Ischemic-type colitis Infectious-type colitis Apoptotic colitis Eosinophils Pseudomembranous colitis Mycophenolate mofetil-related colitis Immune checkpoint inhibitor colitis 

References

  1. 1.
    Carr DF, Ayehunie S, Davies A, et al. Towards better models and mechanistic biomarkers for drug-induced gastrointestinal injury. Pharmacol Ther. 2017;172:181–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Kwak HA, Hart J. The many faces of medication-related injury in the gastrointestinal tract. Surg Pathol Clin. 2017;10:887–908.CrossRefPubMedGoogle Scholar
  3. 3.
    Fosnes GS, Lydersen S, Farup PG. Constipation and diarrhea – common adverse drug reactions? A cross sectional study in the general population. BMC Clin Pharmacol. 2011;11:2.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Villanacci V, Casella G, Bassotti G. The spectrum of drug-related colitides: important entities, though frequently overlooked. Dig Liver Dis. 2011;43:523–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Hayashi PH. Drug-induced liver injury network causality assessment: criteria and experience in the United States. Int J Mol Sci. 2016;17:201.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Marginean EC. The ever-changing landscape of drug-induced injury of the lower gastrointestinal tract. Arch Pathol Lab Med. 2016;140:748–58.CrossRefPubMedGoogle Scholar
  7. 7.
    McCarthy AJ, Lauwers GY, Sheahan K. Iatrogenic pathology of the intestines. Histopathology. 2015;66:15–28.CrossRefPubMedGoogle Scholar
  8. 8.
    Vieth M, Montgomery E. Medication-associated gastrointestinal tract injury. Virchows Arch. 2017;450:245–66.CrossRefGoogle Scholar
  9. 9.
    Voltaggio L, Lam-Himlin D, Limketkai BM, et al. Message in a bottle: decoding medication injury patterns in the gastrointestinal tract. J Clin Pathol. 2014;67:903–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Langer C, Aust D, Ensari A, et al. Histology of microscopic colitis – review with a practical approach for pathologists. Histopathology. 2015;66:613–26.CrossRefGoogle Scholar
  11. 11.
    Rubio-Tapia A, Herman ML, Ludvigsson JF, et al. Severe sprue like enteropathy associated with olmesartan. Mayo Clin Proc. 2012;87:732–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Silva BMD, Neves SJ, Martinez AG, et al. Enteropathy associated with olmesartan. GE Port J Gastroenterol. 2015;23:96–100.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Arnold MA, Swanson BJ, Crowder CD, et al. Colesevelam and colestipol: novel medication resins in the gastrointestinal tract. Am J Surg Pathol. 2014;38:1530–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Swanson BJ, Limketkai BN, Liu TC, et al. Sevelamer crystals in the gastrointestinal tract: a new entity associated with mucosal injury. Am J Surg Pathol. 2013;37:1686–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Rashid A, Hamilton SR. Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol: an underrecognized condition. Am J Surg Pathol. 1997;21:60–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Varma P, Falconer J, Aga A, et al. Rituximab-induced Crohn’s disease. Scand J Gastroenterol. 2017;52:606–8.CrossRefPubMedGoogle Scholar
  17. 17.
    El Fassi D, Nielsen CH, Kjeldsen J, et al. Ulcerative colitis following B lymphocyte depletion with rituximab in a patient with graves’ disease. Gut. 2008;27:714–5.CrossRefGoogle Scholar
  18. 18.
    Bertha M, Bellaguara E, Kuzel T, et al. Checkpoint-inhibitor induced colitis: a new type of inflammatory bowel disease? ACG Case Rep J. 2017;4:e112.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Freeman HJ. Colitis associated with biological agents. World J Gastroenterol. 2012;18:1871–4.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sung D, Iuga AC, Kato T, et al. Crypt apoptotic body counts in normal ileal biopsies overlap with graft-versus-host disease and acute cellular rejection of small bowel allografts. Hum Pathol. 2016;56:89–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Soldini D, Gaspert A, Montani M, et al. Apoptotic enteropathy caused by antimetabolites and TNF-alpha antagonists. J Clin Pathol. 2014;67:582–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Patil D, Odze RD. Biopsy diagnosis of colitis: an algorithmic approach. Virchows Arch. 2018.  https://doi.org/10.1007/s00428-017-2274-0.
  23. 23.
    Conner JR, Kirsch R. The pathology and causes of tissue eosinophilia in the gastrointestinal tract. Histopathology. 2017;71:177–99.CrossRefPubMedGoogle Scholar
  24. 24.
    McCarthy AJ, Sheahan K. Classification of eosinophilic disorders of the small and large intestine. Virchows Arch. 2018.  https://doi.org/10.1007/s00428-017-2249-1.
  25. 25.
    Polydorides AD, Banner BF, Hannaway PJ, et al. Evaluation of site-specific and seasonal variation in colonic mucosal eosinophils. Hum Pathol. 2008;39:832–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Turner KO, Sinkre RA, Neumann WL, et al. Primary colonic eosinophilia and eosinophilic colitis in adults. Am J Surg Pathol. 2017;41:225–33.CrossRefPubMedGoogle Scholar
  27. 27.
    Ahmed S, Gunaratnam NT. Images in clinical medicine: melanosis coli. New Engl J Med. 2003;349:1349.CrossRefPubMedGoogle Scholar
  28. 28.
    Coyne JD. Melanosis coli can involve adenomatous polyps. Histopathology. 2014;64:311–2.CrossRefPubMedGoogle Scholar
  29. 29.
    Blackett JW, Rosenberg R, Mahadev S, et al. Adenoma detection is increased in the setting of melanosis coli. J Clin Gastroenterol. 2018;52(4):313–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Liu ZH, Foo DCC, Law WL, et al. Melanosis coli: harmless pigmentation? A case-control retrospective study of 657 cases. PLoS One. 2017;12:e01186668.Google Scholar
  31. 31.
    Doll R, Hostoffer R. Disappearance of melanosis coli after IVIG. Am J Gastroenterol. 2017;112:517–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Li XA, Zhou Y, Zhou SX, et al. Histopathology of melanosis coli and determination of its associated genes by comparative analysis of expression microarrays. Mol Med Rep. 2015;12:5807–15.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Sagaert X, Tousseyn T, De Hertogh G, et al. Macrophage-related diseases of the gut: a pathologist’s perspective. Virchows Arch. 2012;460:557–67.CrossRefGoogle Scholar
  34. 34.
    Tang DM, Urrunaga NH, von Rosenvinge EC. Pseudomembranous colitis: not always Clostridium difficile. Cleve Clin J Med. 2016;83:361–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Jung SW, Jeon SW, Byung-Hun D, et al. Clinical aspects of rifampicin-associated pseudomembranous colitis. J Clin Gastroenterol. 2007;41:38–40.CrossRefPubMedGoogle Scholar
  36. 36.
    Sato S, Chinda D, Yamai K, et al. A case of severe pseudomembranous colitis diagnosed by colonoscopy after Helicobacter pylori eradication. Clin J Gastroenterol. 2014;7:247–50.CrossRefPubMedGoogle Scholar
  37. 37.
    Permpalung N, Upala S, Sanguankeo A, et al. Association between NSAIDs and Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Can J Gastroenterol. 2016;2016:7431838.Google Scholar
  38. 38.
    Dignan C, Joel G. Can ischemic colitis be differentiated from C difficile colitis in biopsy specimens? Am J Surg Pathol. 1997;21:706–10.CrossRefPubMedGoogle Scholar
  39. 39.
    Wiland HO, Procop GW, Goldblum JR, et al. Interobserver variability and feasibility of polymerase chain reaction-based assay in distinguishing ischemic colitis from Clostridium difficile colitis in endoscopic mucosal biopsies. Am J Clin Pathol. 2013;139:730–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Chhatrala R, Patel S, Chow W. Pseudomembranes do not always indicate Clostridium difficile infection. Clin Gastroenterol Hepatol. 2014;12:A21–2.CrossRefPubMedGoogle Scholar
  41. 41.
    Yuan S, Reyes V, Bronner MP. Pseudomembranous collagenous colitis. Am J Surg Pathol. 2003;27:1375–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Cameselle-Teijeiro J, Abulkader I, Forteza J. Signet-ring cell change in pseudomembranous colitis versus signet-ring cell carcinoma. Am J Surg Pathol. 2004;28:1111.CrossRefPubMedGoogle Scholar
  43. 43.
    Tzardi M, Papadakis M, Giannikaka E, et al. Pseudomembranous colitis with presence of signet-ring cells: report of two cases and review of the literature. Ann Gastroenterol. 2011;24:222–4.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Maes BD, Dalle I, Geboes K, et al. Erosive enterocolitis in mycophenolate mofetil-treated renal-transplant recipients with persistent afebrile diarrhea. Transplantation. 2003;75:665–72.CrossRefPubMedGoogle Scholar
  45. 45.
    Dalle I, Maes BD, Geboes KP, et al. Crohn’s-like change in the colon due to mycophenolate? Color Dis. 2005;7:27–34.CrossRefGoogle Scholar
  46. 46.
    Selbst MK, Ahrens WA, Robert ME, et al. Spectrum of histological changes in colonic biopsies in patients treated with mycophenolate mofetil. Mod Pathol. 2009;22:737–43.CrossRefPubMedGoogle Scholar
  47. 47.
    Calmet FH, Yarur AJ, Pukazhendhi G, et al. Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation. Ann Gastroenterol. 2015;28:366–73.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Goyal A, Salahuddin M, Govil Y. A unique case of mycophenolate colitis after 10 years of use. Case Rep Gastrointestin Med. 2016;2016:3058407.Google Scholar
  49. 49.
    Curtin BF, Rachakonda VP, Von Rosenvinge EC. Unusually late-onset mycophenolate mofetil-related colitis. Am J Health Syst Pharm. 2014;71:1858–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Assarzadegan N, Montgomery E, Anders RA. Immune inhibitor checkpoint colitis: the flip side of the wonder drugs. Virchows Arch. 2018.  https://doi.org/10.1007/s00428-017-2267-z.
  51. 51.
    Michot JM, Bigenwald C, Champiat S, et al. Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer. 2016;54:139–48.CrossRefPubMedGoogle Scholar
  52. 52.
    Gonzalez RS, Salaria SN, Bohannon CD, et al. PD-1 inhibitor gastroenterocolitis: case series and appraisal of “immunomodulatory gastroenterocolitis”. Histopathology. 2017;70:558–67.CrossRefPubMedGoogle Scholar
  53. 53.
    Chen JH, Pezhouh MK, Lauwers GY, et al. Histopathological features of colitis due to immunotherapy with anti-PD-1 antibodies. Am J Surg Pathol. 2017;41:643–54.CrossRefPubMedGoogle Scholar
  54. 54.
    Bavi P, Butler M, Serra S, et al. Immune modulator-induced changes in the gastrointestinal tract. Histopathology. 2017;71:494–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Oble DA, Mino-Kenudson M, Goldsmith J, et al. Alpha-CTLA-4 mAb-associated panenteritis: a histological and immunohistochemical analysis. Am J Surg Pathol. 2008;32:1130–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Louie CY, DiMaio MA, Matsukuma KE, et al. Idelalisib-associated enterocolitis: clinicopathological features and distinction from other enterocolitides. Am J Surg Pathol. 2015;39:1653–60.CrossRefPubMedGoogle Scholar
  57. 57.
    Weidner AS, Panarelli NC, Geyer JT, et al. Idelalisib-associated colitis: histologic findings in 14 patients. Am J Surg Pathol. 2015;39:1661–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Louis Libbrecht
    • 1
  • Anne Jouret-Mourin
    • 1
  • Karel Geboes
    • 2
    • 3
  1. 1.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  2. 2.Department of PathologyGhent University HospitalGhentBelgium
  3. 3.Department of PathologyKU LeuvenLeuvenBelgium

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