Triggers of histologically suspected drug-induced colitis  

作　　者：Thorsten Brechmann Katharina Günther Matthias Neid Wolff Schmiegel Andrea Tannapfel 

机构地区：[1]Department of Gastroenterology and Hepatology,Ruhr-University Bochum,Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil gGmbH,Bochum 44789,Germany [2]Institute of Pathology,Ruhr-University Bochum,Bochum 44789,Germany [3]Department of Internal Medicine,University Hospital Knappschaftskrankenhaus,Ruhr-University Bochum,Bochum 44892,Germany

出　　处：《World Journal of Gastroenterology》2019年第8期967-979,共13页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Drug toxicity is a common and even serious problem in the gastrointestinal tract that is thought to be caused by a broad spectrum of agents.Although withdrawal of the causative agent would cure the disease knowledge is scarce and mostly derives from case reports and series.AIM To investigate potential triggers of drug-induced colitis(DiC).METHODS We conducted a retrospective,observational case control study.Patients were assigned to DiC or one of two age-and gender-matched control groups(noninflammatory controls and inflammatory colitis of another cause)based on histopathological findings.Histopathology was reassessed in a subset of patients(28 DiC with atherosclerosis,DiC without atherosclerosis and ischaemic colitis each)for validation purposes.Medical history was collected from the electronic database and patient records.Statistical analysis included chi-squared test,t-test,logistic and multivariate regression models.RESULTS Drug-induced colitis was detected in 211 endoscopically sampled biopsy specimens of the colon mucosa(7%of all screened colonoscopic biopsy samples);a total of 633 patients were included equally matched throughout the three groups(291 males,mean age:62.1±16.1 years).In the univariate analysis,DiC was associated with diuretics,dihydropyridines,glycosides,ASS,platelet aggregation inhibitors,nonsteroidal anti-inflammatory drugs(NSAIDs),statins and fibrates,and with atherosclerosis,particularly coronary heart disease,and hyperlipoproteinaemia.Echocardiographic parameters did not show substantial differences.In the multivariate analysis only fibrates[odds ratio(OR)=9.1],NSAIDs(OR=6.7)and atherosclerosis(OR=2.1)proved to be associated with DiC.Both DiC reassessment groups presented milder inflammation than ischaemic colitis.The DiC patients with atherosclerosis exhibited histological features from both DiC without atherosclerosis and ischaemic colitis.CONCLUSION Several drugs indicated for the treatment of cardiovascular and related diseases are associated with DiC.Atherosclerosis andBACKGROUND Drug toxicity is a common and even serious problem in the gastrointestinal tract that is thought to be caused by a broad spectrum of agents. Although withdrawal of the causative agent would cure the disease knowledge is scarce and mostly derives from case reports and series.AIM To investigate potential triggers of drug-induced colitis(Di C).METHODS We conducted a retrospective, observational case control study. Patients were assigned to Di C or one of two age-and gender-matched control groups(noninflammatory controls and inflammatory colitis of another cause) based on histopathological findings. Histopathology was reassessed in a subset of patients(28 Di C with atherosclerosis, Di C without atherosclerosis and ischaemic colitis each) for validation purposes. Medical history was collected from the electronic database and patient records. Statistical analysis included chi-squared test, t-test,logistic and multivariate regression models.RESULTS Drug-induced colitis was detected in 211 endoscopically sampled biopsy specimens of the colon mucosa(7% of all screened colonoscopic biopsy samples);a total of 633 patients were included equally matched throughout the three groups(291 males, mean age: 62.1 ± 16.1 years). In the univariate analysis, Di C was associated with diuretics, dihydropyridines, glycosides, ASS, platelet aggregation inhibitors, nonsteroidal anti-inflammatory drugs(NSAIDs), statins and fibrates, and with atherosclerosis, particularly coronary heart disease, and hyperlipoproteinaemia. Echocardiographic parameters did not show substantial differences. In the multivariate analysis only fibrates [odds ratio(OR) = 9.1],NSAIDs(OR = 6.7) and atherosclerosis(OR = 2.1) proved to be associated with Di C. Both Di C reassessment groups presented milder inflammation than ischaemic colitis. The Di C patients with atherosclerosis exhibited histological features from both Di C without atherosclerosis and ischaemic colitis.CONCLUSION Several drugs indicated for the treatment of cardiovascular and related dise

关 键 词：Drug toxicity Drug-induced colitis Ischaemic colitis Drug-associated gastrointestinal disease Atherosclerosis Colonic ischaemia Nonsteroidal antiinflammatory drugs FIBRATES 

分 类 号：R[医药卫生]