Bezoar by mesalazine tablets: cause of intestinal obstruction in Crohn's disease

Abstract

The stricturing and fistulizing forms of Crohn's disease (CD) exhibit many different results to clinical treatment and good response to surgical therapy. The prevalence of strictures in CD ranges from 12 to 54% and they are more frequently in patients with longer disease duration, and the terminal ileum is the most commonly affected location. The pharmacobezoars can be formed in any part of the gastrointestinal tract and are often associated with factors predisposing anatomic, functional or other concomitant conditions. The pharmacological properties of drugs may contribute to the pathophysiology of bezoars. The objective of this case report is to alert for the importance of the quality of prescribed medications that are used by patients with CD, through the finding of more than 350 tablets of mesalazine during the surgical treatment of a patient with the fibrostenotic pattern.ReSumo: As formas estenosante e fistulizante da doença de Crohn (DC) apresentam resultado variável ao tratamento medicamentoso e boa resposta à terapia cirúrgica. A prevalência da DC estenosante varia de 12 a 54%, mais frequente nos pacientes com maior tempo de doença, sendo o íleo terminal o local mais acometido. Os farmacobenzoares podem se formar em qualquer porção do trato gastrointestinal e frequentemente estão associados a fatores anatômicos predisponentes, funcionais ou outras afecções concomitantes. As propriedades farmacológicas dos medicamentos podem contribuir na fisiopatologia da formação dos benzoares. O objetivo deste trabalho é alertar para a importância da qualidade dos fármacos prescritos e utilizados pelos pacientes com DC, por meio do achado de mais de 350 comprimidos de mesalazina

Gastric Pharmacobezoar of Mesalamine Tablets Retrieved Endoscopically

“…Only two similar cases were previously reported in the literature for Crohn’s disease patients due to mesalamine tablets. 1 , 2 In our case, the stricture at the pylorus prevented the tablets from passing beyond the stomach, thus forming pharmacobezoars. Endoscopic examination plays an important role in diagnosing pharmacobezoars.…”

“…Crohn’s disease is a stricturing disease of the GI tract, and stricture at the pylorus may impede the movement of gastric contents, thereby promoting the formation of a pharmacobezoar. Only two similar cases were previously reported in the literature for Crohn’s disease patients due to mesalamine tablets 1,2. In our case, the stricture at the pylorus prevented the tablets from passing beyond the stomach, thus forming pharmacobezoars.…”

“…Bulk-forming laxatives, extended release formulations, drugs (eg, nifedipine, verapamil, procainamide, ferrous sulphate, theophylline, and cholestyramine), prior gastric surgery, and Crohn’s disease predispose to bezoar formation. 1 Mesalamine tablets usually release salt at pH 7 in the terminal ileum and colon. The pH of the stomach is usually less than 7, so these tablets do not release salt in stomach.…”

Pharmacobezoar—a rare case presented as gastric outlet obstruction

“…It works by reducing or stopping the production of natural chemicals which cause inflammation, swelling, tissue damage and diarrhoea. It does not get dissolved in acidic media and there is no dissolution therapy available for it [ 5 ].…”

An Unusual Presentation of Crohn’s Disease Diagnosed Following Accidental Ingestion of Fruit Pits: Report of Two Cases and Review of the Literature

“…The presence of strictures in CD ranges from 12 to 54%, being most frequent in patients who have longstanding disease, and the terminal ileum is the most affected location [2][3][4][5]. The stricturing phenotype is characterized by the inflammatory and/or fibrotic luminal reduction of one or more segments of the gastrointestinal tract (GIT).…”