Drug-induced gastrointestinal disease

Abstract

The gastrointestinal tract is a common target for adverse drug reactions. The resultant changes are often nonspecific (e.g., mucosal ulceration, intestinal infarction, motility disturbance) and in many cases no radiographically detectable lesion may occur. A comprehensive review of the reported drug-induced disorders of the digestive organs is herein presented and their radiographic manifestations are described.

Drug-induced disorders of the colon

“…The reported fatality rate is about 40%, and most of the patients have been middle-aged women. Ulcerative changes and edema have been described in both the colon and small bowel on barium examinations [3]. The mechanism is unknown, but at least one individual with an allergic-appearing eosinophilic enterocolitis was successfully treated with cromolyn sodium [25].…”

“…The diagnosis is often made at barium enema, which demonstrates an atonic and redundant colon with an ahaustral tubular appearance. The changes are predominantly right sided and often associated with a patulous ileocecal valve and a dilated terminal ileum mimicking backwash ileitis [3,21]. The entire colon may be involved, and the differentiation with ulcerative colitis is generally made by the appropriate history, the lack of colonic shortening and mucosal ulceration in cathartic colon, and the presence of pseudopolyps and strictures in ulcerative colitis.…”

“…They are prone to frequent constipation and possible sigmoid volvulus due to chronic dilation and elongation of the colon [2]. Phenothiazines and tricyclic antidepressants can have similar adverse effects on the colon, leading to fecal impaction and paralytic ileus, sometimes requiring surgery, [3][4][5]. The combination therapy with Correspondence to: M. I. Burrell anticholinergics and psychoactive drugs may affect both the small intestine and the large bowel.…”

“…2). Abdominal radiographs showing a large amount of stool in the colon along with the appropriate drug history, can establish the diagnosis and prompt treatment with nasogastric suction and bisacodyl suppositories [3]. Severe stercoral ulcers can occasionally complicate fecal impaction in these patients.…”

Study of the Gastric Mucosa in Rheumatic Patients Before and After the Administration of Flurbiprofen

“…Nonsteroidal anti-inflammatory agents may lead to gastrointestinal symptoms and their ulcerogenic potential is the most important (3,4,5,6,7). Abdominal discomfort, nausea, dyspepsia and constipation are mentioned in the literature as the most frequent complaints of patients treated with flurbiprofen 0, 8,9).…”