Drug Effects on the Gastrointestinal Tract

  • Vishal Jain
  • T. S. Dharmarajan
  • T. S. Dharmarajan
  • T. S. Dharmarajan
  • T. S. Dharmarajan
  • C. S. Pitchumoni
  • C. S. Pitchumoni
  • C. S. Pitchumoni


Gastrointestinal manifestations resulting from either prescribed medications or over-the-counter drugs are commonly encountered in clinical practice and often mistaken for a disease process or syndrome, leading to multiple and unnecessary diagnostic studies. The morbidity, mortality, and health care costs associated with adverse drug events, even restricted to the GI tract, are underestimated. The consequences of adverse effects may be asymptomatic or range from mild discomfort to fatal hemorrhage or perforation. Better awareness and recognition of the intended and unacceptable effects of drugs on the gastrointestinal tract and withdrawing the medication or revising the regimen will help improve outcomes.


Lower Esophageal Sphincter Adverse Drug Event Capsule Endoscopy Ischemic Colitis Video Capsule Endoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    FDA. Annual adverse drug report 1995. 1995. http://www.fda.gov/cder/reports/annrep95.pdf.
  2. 2.
    Jorgensen T, Johansson S, Kennerfalk A, et al. Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother. 2001;35(9):1004–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician’s guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795–801.PubMedGoogle Scholar
  4. 4.
    Nolan L, O’Malley K. Prescribing for the elderly. Part I: sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc. 1988;36(2):142–9.PubMedGoogle Scholar
  5. 5.
    Jain V, Pitchumoni CS. Gastrointestinal side effects of prescription medications in the older adult. J Clin Gastroenterol. 2009;43(2):103–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315(7115):1096–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Abdollahi M, Radfar M. A review of drug-induced oral reactions. J Contemp Dent Pract. 2003;4(1):10–31.PubMedGoogle Scholar
  8. 8.
    Roujeau JC, Kelly JP, Naldi L, et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med. 1995;333(24):1600–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Unnikrishnan D, Murakonda P, Dharmarajan TS. If it is not cough, it must be dysgeusia: differing adverse effects of angiotensin-converting enzyme inhibitors in the same individual. J Am Med Dir Assoc. 2004;5(2):107–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Taybos G. Oral changes associated with tobacco use. Am J Med Sci. 2003;326(4):179–82.PubMedCrossRefGoogle Scholar
  11. 11.
    Carlborg B, Densert O. Esophageal lesions caused by orally administered drugs. An experimental study in the cat. Eur Surg Res. 1980;12(4):270–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Abid S, Mumtaz K, Jafri W, et al. Pill-induced esophageal injury: endoscopic features and clinical outcomes. Endoscopy. 2005;37(8):740–4.PubMedCrossRefGoogle Scholar
  13. 13.
    O’Neill JL, Remington TL. Drug-induced esophageal injuries and dysphagia. Ann Pharmacother. 2003;37(11):1675–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Castell DO, Murray JA, Tutuian R, et al. The pathophysiology of gastro-oesophageal reflux disease—oesophageal manifestations. Aliment Pharmacol Ther. 2004;20 Suppl 9:14–25.PubMedCrossRefGoogle Scholar
  15. 15.
    Shaker R. Gastroesophageal reflux disease: beyond mucosal injury. J Clin Gastroenterol. 2007;41 Suppl 2:S160–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Lichtenstein DR, Syngal S, Wolfe MM. Nonsteroidal antiinflammatory drugs and the gastrointestinal tract. The double-edged sword. Arthritis Rheum. 1995;38(1):5–18.PubMedCrossRefGoogle Scholar
  17. 17.
    Schoen RT, Vender RJ. Mechanisms of nonsteroidal anti-inflammatory drug-induced gastric damage. Am J Med. 1989;86(4):449–58.PubMedCrossRefGoogle Scholar
  18. 18.
    Dominick KL, Ahern FM, Gold CH, Heller DA. Gender differences in NSAID use among older adults with osteoarthritis. Ann Pharmacother. 2003;37(11):1566–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Garcia Rodriguez LA, Cattaruzzi C, Troncon MG, Agostinis L. Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Intern Med. 1998;158(1):33–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Griffin MR, Piper JM, Daugherty JR, et al. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991;114(4):257–63.PubMedGoogle Scholar
  21. 21.
    Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Allison MC, Howatson AG, Torrance CJ, et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med. 1992;327(11):749–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Gibson GR, Whitacre EB, Ricotti CA. Colitis induced by nonsteroidal anti-inflammatory drugs. Report of four cases and review of the literature. Arch Intern Med. 1992;152(3):625–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Li F, Gurudu SR, De Petris G, Sharma VK, et al. Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc. 2008;68(1):174–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Vandraas KF, Spigset O, Mahic M, Slordal L. Non-steroidal anti-inflammatory drugs: use and co-treatment with potentially interacting medications in the elderly. Eur J Clin Pharmacol. 2010;66(8):823–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Rahme E, Barkun A, Nedjar H, et al. Hospitalizations for upper and lower GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec, Canada. Am J Gastroenterol. 2008;103(4):872–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Pusztaszeri MP, Genta RM, Cryer BL. Drug-induced injury in the gastrointestinal tract: clinical and pathologic considerations. Nat Clin Pract Gastroenterol Hepatol. 2007;4(8):442–53.PubMedCrossRefGoogle Scholar
  28. 28.
    Ingoldby CJ. Perforated jejunal diverticulum due to local iron toxicity. BMJ. 1977;1(6066):949–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Saltzman JR, Kowdley KV, Pedrosa MC, et al. Bacterial overgrowth without clinical malabsorption in elderly hypochlorhydric subjects. Gastroenterology. 1994;106(3):615–23.PubMedGoogle Scholar
  30. 30.
    Dharmarajan TS, Kanagala MR, Murakonda P, et al. Do acid-lowering agents affect vitamin B12 status in older adults? J Am Med Dir Assoc. 2008;9(3):162–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Stamm C, Burkhalter CE, Pearce W, et al. Benign colonic ulcers associated with nonsteroidal antiinflammatory drug ingestion. Am J Gastroenterol. 1994;89(12):2230–3.PubMedGoogle Scholar
  32. 32.
    Halter F, Weber B, Huber T, et al. Diaphragm disease of the ascending colon. Association with sustained-release diclofenac. J Clin Gastroenterol. 1993;16(1):74–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin North Am. 1992;72(1):203–29.PubMedGoogle Scholar
  34. 34.
    Cappell MS. Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol. 2004;99(6):1175–90.PubMedCrossRefGoogle Scholar
  35. 35.
    Dial S, Delaney JA, Schneider V, Suissa S. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ. 2006;175(7):745–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Al-Tureihi FI, Hassoun A, Wolf-Klein G, Isenberg H. Albumin, length of stay, and proton pump inhibitors: key factors in Clostridium difficile-associated disease in nursing home patients. J Am Med Dir Assoc. 2005;6(2):105–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Linsky A, Gupta K, Lawler EV, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med. 2010;170(9):772–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Muto CA, Pokrywka M, Shutt K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol. 2005;26(3):273–80.PubMedCrossRefGoogle Scholar
  39. 39.
    Petruzzelli GJ, Johnson JT, de Vries EJ. Neutropenic enterocolitis. A new complication of head and neck cancer chemotherapy. Arch Otolaryngol Head Neck Surg. 1990;116(2):209–11.PubMedCrossRefGoogle Scholar
  40. 40.
    Grunkemeier DM, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clin Gastroenterol Hepatol. 2007;5(10):1126–39; quiz 1121–2.Google Scholar
  41. 41.
    Dharmarajan TS, Kumar A, Pitchumoni CS. Drug-nutrient interactions in older adults. Pract Gastroenterol. 2002;26(9):37–55.Google Scholar
  42. 42.
    Gizzi G, Villani V, Brandi G, et al. Ano-rectal lesions in patients taking suppositories containing non-steroidal anti-inflammatory drugs (NSAIDs). Endoscopy. 1990;22(3):146–8.PubMedCrossRefGoogle Scholar
  43. 43.
    de Parades V, Sultan S, Bauer P. Ano-rectal and colonic complications of suppositories and enemas. Gastroenterol Clin Biol. 1996;20(5):446–52.PubMedGoogle Scholar
  44. 44.
    Lankisch PG, Droge M, Gottesleben F. Drug induced acute pancreatitis: incidence and severity. Gut. 1995;37(4):565–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Badalov N, Baradarian R, Iswara K, et al. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol. 2007;5(6):648–61; quiz 4.Google Scholar
  46. 46.
    Trivedi CD, Pitchumoni CS. Drug-induced pancreatitis: an update. J Clin Gastroenterol. 2005;39(8):709–16.PubMedCrossRefGoogle Scholar
  47. 47.
    Pariente A, Sanctussy DJ, Miremont-Salame G, et al. Factors associated with serious adverse reactions to cholinesterase inhibitors: a study of spontaneous reporting. CNS Drugs. 2010;24(1):55–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Becker WC, O’Connor PG. The safety of opioid analgesics in the elderly: new data raise new concerns: comment on “the comparative safety of opioids for nonmalignant pain in older adults”. Arch Intern Med. 2010;170(22):1986–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Cho S, Lau SWJ, Tandon V, et al. Geriatric drug evaluation. Where are we now and where should we be in the future? Arch Intern Med. 2011;171(10):937–40.PubMedCrossRefGoogle Scholar
  50. 50.
    Hiraishi H, Maeda M, Sasai T, et al. Strategy to manage low dose aspirian-induced gastrointestinal injury. Nippon Rinsho. 2011;69(2):369–75.PubMedGoogle Scholar
  51. 51.
    Laria A, Zoli A, Gremese E, Ferraccioli GF. Proton pump inhibitors in rheumatic diseases; clinical practice, drug interactions, bone fractures and risk of infections. Reumatismo. 2011;63(1):5–10.PubMedGoogle Scholar
  52. 52.
    Schulman S, Majeed A. A benefit-risk assessment of dabigatran in the prevention of venous thromboembolism in orthopaedic surgery. Drug Saf. 2011;3496:449–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Vishal Jain
    • 1
  • T. S. Dharmarajan
    • 2
  • T. S. Dharmarajan
    • 3
  • T. S. Dharmarajan
    • 4
  • T. S. Dharmarajan
    • 5
  • C. S. Pitchumoni
    • 6
  • C. S. Pitchumoni
    • 2
  • C. S. Pitchumoni
    • 7
  1. 1.Department of Gastroenterology and HepatologyPenn State Hershey Medical CenterHersheyUSA
  2. 2.New York Medical CollegeValhallaUSA
  3. 3.Department of MedicineMontefiore Medical Center (North Division)BronxUSA
  4. 4.Division of GeriatricsMontefiore Medical Center (North Division)BronxUSA
  5. 5.Geriatric Medicine Fellowship ProgramMontefiore Medical Center (North Division)BronxUSA
  6. 6.Robert Wood Johnson School of Medicine, Drexel University School of MedicinePhiladelphiaUSA
  7. 7.Gastroenterology, Hepatology and NutritionSaint Peter’s University HospitalNew BrunswickUSA

Personalised recommendations