Dore Maria Pina, Villanacci Vincenzo, Manca Alessandra, Soro Sara, Schiavo-Lena Marco, Sabatino Giuseppe, Graham David Yates, Bassotti Gabrio
Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
Intern Emerg Med. 2014 Jun;9(4):405-9. doi: 10.1007/s11739-013-0930-1. Epub 2013 Mar 15.
Drug-induced damage to the gastrointestinal mucosa has been mainly focused on damage in the upper tract. However, increasing evidence suggests that commonly used drugs may also affect the mucosa of the lower gut, and particularly in the colon. The aim of this study was to report that fairly homogeneous colonoscopic findings, correlate with histological evidence of drug-induced mucosal injury. Charts of patients with the "cherry tree" colonoscopic aspect were reviewed to correlate the endoscopic and histological findings for a possible association with the use of drugs. Data from 29 patients (5 men, 24 women, age range 16-76 years) with the "cherry tree" colonoscopic findings were analyzed. Histology revealed an increase in eosinophils in the left colon in 23 patients, pseudomelanosis coli in 3, and microscopic colitis in 3. The findings were associated with proton pump inhibitors in 19 (65.5 %), non-steroidal anti-inflammatory drugs or statins (3 cases each), and other drugs [4 cases, including estroprogestinics (1), antidepressants (2), and thyroxin (1)]. The "cherry tree" colonoscopic appearance suggests drug-induced colonic damage. Awareness of this association may prevent unnecessary, expensive and time-consuming procedures.
药物引起的胃肠道黏膜损伤主要集中在上消化道。然而，越来越多的证据表明，常用药物也可能影响下消化道黏膜，尤其是结肠黏膜。本研究的目的是报告相当一致的结肠镜检查结果，与药物引起的黏膜损伤的组织学证据相关。回顾了具有“樱桃树”样结肠镜表现患者的病历，以关联内镜和组织学检查结果，探讨其与药物使用的可能关联。分析了29例（5例男性，24例女性，年龄范围16 - 76岁）具有“樱桃树”样结肠镜表现患者的数据。组织学检查显示，23例患者左半结肠嗜酸性粒细胞增多，3例为结肠黑变病，3例为显微镜下结肠炎。这些发现与质子泵抑制剂有关的有19例（65.5%），与非甾体抗炎药或他汀类药物有关的各3例，与其他药物有关的4例[包括雌激素孕激素类药物（1例）、抗抑郁药（2例）和甲状腺素（1例）]。“樱桃树”样结肠镜表现提示药物引起的结肠损伤。认识到这种关联可能避免不必要的、昂贵且耗时的检查程序。
