Samra Kiran, Manikam Logan, Pathmakanthan Shri
University Hospitals of North Midlands, Stoke-On-Trent, UK.
University College London, London, UK.
BMJ Case Rep. 2015 May 24;2015:bcr2015209799. doi: 10.1136/bcr-2015-209799.
A 75-year-old woman presented with severe abdominal pain and diarrhoea. Symptoms started 10 years earlier but multiple investigations failed to offer a clear diagnosis. On recent admission, blood tests, endoscopies and CT scans indicated chronic colonic inflammation. Treatment strategies for bowel inflammation were unsuccessful and the patient was subsequently discussed at a multidisciplinary team meeting with surgeons for consideration of colectomy. A drug review highlighted that the patient was taking an antiangina drug, nicorandil, thought to cause bowel ulceration. This was discontinued, which dramatically improved symptoms and avoided surgery and the patient was discharged within days. Follow-up colonoscopy showed much improved colitis, and the diarrhoea had resolved. It is important that clinicians are aware of the link between pharmacotherapy, specifically nicorandil and gastrointestinal ulceration and inflammation causing severe diarrhoea. Drug cessation is the only necessary and immediately effective treatment. Awareness of this will become more clinically relevant as nicorandil use increases.
一名75岁女性出现严重腹痛和腹泻。症状始于10年前，但多次检查未能明确诊断。近期入院时，血液检查、内镜检查和CT扫描显示为慢性结肠炎症。肠道炎症的治疗策略未成功，随后在多学科团队会议上与外科医生讨论了该患者，考虑进行结肠切除术。药物审查发现该患者正在服用一种抗心绞痛药物尼可地尔，据认为该药物会导致肠道溃疡。停用该药物后，症状显著改善，避免了手术，患者在数天内出院。随访结肠镜检查显示结肠炎明显改善，腹泻也已缓解。临床医生必须意识到药物治疗之间的联系，特别是尼可地尔与胃肠道溃疡以及导致严重腹泻的炎症之间的联系。停药是唯一必要且立即有效的治疗方法。随着尼可地尔使用的增加，对此的认识在临床上将变得更加重要。
