Colitis microscópica y exposición a fármacos: una revisión crítica

Lucendo, Alfredo J.; Fernández‐Bañares, Fernando

doi:10.1016/j.eii.2015.08.004

Cited by 3 publications

(2 citation statements)

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“…The recent American Gastroenterological Institute Guidelines for the management of MC in fact considers several drugs, including non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), clozapine, and acarbose as precipitating causes for MC [ 29 ]. However, the degree of cause–effect plausibility on which these observations are supported is widely variable [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Drug Exposure and the Risk of Microscopic Colitis: A Critical Update

Lucendo

2017

Drugs R D

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A variety of luminal antigens, including a wide range of drugs, have been associated with the still little-known pathophysiology of microscopic colitis (MC), with variable evidence suggesting causality. This article aims to review the aspects related to drugs as potential triggers of MC; to discuss the most commonly identified associations between drugs and MC; and to analyze the limitations of the studies currently available. A literature search was performed in PubMed combining the search terms ‘drug exposure’, ‘drug consumption’, and ‘risk factors’ with ‘microscopic colitis’, ‘lymphocytic colitis’, and ‘collagenous colitis’, with no language restrictions. Reference lists of retrieved documents were also reviewed. A handful of case–control studies have demonstrated significant associations between some commonly used drugs and a higher risk of developing MC. No universally accepted criteria for establishing cause–effect relationships in adverse reactions to drugs are available, but several methods that can be applied to MC, can provide degrees of the likelihood of an association. A high probability imputation in the development of MC as a drug adverse effect has only been demonstrated for individual cases by applying chronological (challenge, de-challenge, and relapse with re-challenge) and semiological criteria. Several case–control studies have shown significant associations between exposure to drugs and MC, but the variability in their design, the reference populations used, and the definitions for drug exposure considered require specific analyses. It can be concluded that drug exposure and MC as a likely cause–effect relationship has only been described for a handful of drugs and in individual cases.

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Section: Introductionmentioning

confidence: 99%

Drug Exposure and the Risk of Microscopic Colitis: A Critical Update

Lucendo

2017

Drugs R D

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“…Desde la década de 1990 se ha considerado el uso permanente de algunos medicamentos (Tabla 1) como causante o precipitante de la CM (34, 35). Las guías del Instituto Americano de Gastroenterología para el manejo de la CM consideran varios medicamentos, que incluyen los antiinflamatorios no esteroideos (AINE), la aspirina, los inhibidores de la bomba de protones (IBP), los inhibidores selectivos de la recaptación de serotonina (ISRS), la clozapina y la acarbosa; sin embargo, el grado de relación causa efecto es muy variable de acuerdo con los diversos informes (32,36,37 De los factores ambientales, fumar es el factor de riesgo mejor documentado para CM. Varios estudios han demostrado que el tabaquismo está asociado con CC y con CL.…”

Section: Tratamientounclassified

Colitis microscópica, un diagnóstico en aumento

2019

Rev Colomb Gastroenterol

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Actualmente, la colitis microscópica agrupa tres subgrupos de patologías, las clásicas son la colitis linfocítica (CL) y la colitis colagenosa (CC), que histológicamente se distinguen por la presencia o ausencia de engrosamiento subepitelial; el tercer subgrupo corresponde a la colitis microscópica incompleta (CMI), que incluye a pacientes que no cumplen los criterios clásicos de colitis microscópica, pero que presentan cambios histológicos similares. Aunque se considera una enfermedad con baja prevalencia e incidencia, los estudios presentados en los últimos años evidencian un incremento leve de esta patología. Se han mencionado como factores causales los inmunológicos e infecciosos y se ha relacionado con el consumo de algunos medicamentos y de cigarrillo. Clínicamente se caracteriza por la presencia de diarrea acuosa crónica, que en algunos pacientes puede cursar con períodos de estreñimiento. Los tres subgrupos presentan manifestaciones clínicas similares, por lo que su diagnóstico generalmente es histológico. La colonoscopia con toma de biopsias es el pilar diagnóstico y se debe complementar con hemograma, examen parasitológico, estudios inmunológicos (anticuerpos antinucleares, IgG) y de función tiroidea. El tratamiento se basa en la suspensión de medicamentos relacionados, cambios en los hábitos alimenticios y en el uso de medicamentos, como los esteroides, subsalicilato de bismuto, 5-ASA y colestiramina. En la gran mayoría de los pacientes, la mejoría se logra con un bajo porcentaje de recidivas.

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