Lansoprazole-associated microscopic colitis: a case series1

Abstract

Lansoprazole is a potent proton pump inhibitor that has been well tolerated with minimal serious adverse events. One of the most commonly reported side effects is diarrhea in 3-8% of study patients. During 1997, approximately 850 veterans at our institution had their proton pump inhibitor converted from omeprazole to lansoprazole because of a formulary change. A number of patients subsequently developed chronic watery diarrhea. While evaluating six of these patients, we discovered microscopic colitis that resolved with discontinuation of lansoprazole. The diarrhea was described as three to 10 loose, nonbloody bowel movements per day with some abdominal cramping. Colonoscopy in five patients and flexible sigmoidoscopy in one patient revealed normal colonic mucosa, but random biopsies all supported microscopic colitis (five cases of lymphocytic colitis and one case of collagenous colitis). Complete symptom resolution occurred in all patients within 4 to 10 days of discontinuing lansoprazole. In all patients, follow-up biopsies demonstrated normalization of the colonic histology. This is the first published case series of patients with microscopic colitis that correlated clinically and histologically with the initiation and discontinuation of lansoprazole.

Clinical and fiscal impact of lansoprazole intolerance in veterans with gastro‐oesophageal reflux disease

“…Of these patients, 91% had resolution of their diarrhoea when placed on omeprazole. Microscopic colitis has been described in association with lansoprazole, and resolved after discontinuation of the drug 18 . While the incidence of diarrhoea in our study appears low (24/3703=0.65%), this number is probably a gross underestimation of the total number of patients on lansoprazole at our institutions who have had diarrhoea in association with a proton pump inhibitor.…”

Microscopic Colitis: a Clinical and Pathological Review

“…In a case-control study of 31 patients with collagenous colitis, 61% had recently used NSAIDs compared with 13% of age and sex-matched controls with irritable bowel syndrome or diverticular disease (27). Lansoprazolerelated microscopic colitis has been reported in two other studies (29,30). In addition, Baert et al, reported that 7 of 28 patients with collagenous colitis were taking lansoprazole or omeprazole at the time of diagnosis (14).…”

Endoscopic and Histopathological Evaluation of Collagenous Colitis

“…While CC has been described as an unexplained inflammatory bowel disease, drug-induced CC and possible involvement of autoimmune mechanisms in the onset of CC have been reported [5,6,7]. In Japan, most of the recently reported cases had a history of use of LPZ, a type of PPI, and some studies have suggested that endoscopically documented longitudinal linear lacerations of the mucosa might be the cause of CC [8,9].…”