Movement Disorder Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
Movement Disorder Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia; Neurology Department, Blacktown Hospital, 18 Blacktown Rd, Blacktown, NSW, 2148, Australia.
Parkinsonism Relat Disord. 2021 May;86:84-90. doi: 10.1016/j.parkreldis.2021.03.031. Epub 2021 Apr 20.
Microscopic colitis is a form of inflammatory bowel disease characterized by profuse non-bloody watery diarrhea. Macroscopic abnormality is not present on colonoscopy, and it requires biopsy for diagnosis. Few cases have been attributed to levodopa/dopa-decarboxylase inhibitor therapy.
A retrospective cohort study of 21 patients on levodopa/benserazide and one patient on levodopa-carbidopa intestinal gel with clinically suspected or biopsy proven microscopic colitis.
All 21 patients on oral levodopa/benserazide had resolution of diarrhea with cessation of the medication. Four patients discontinued levodopa permanently. Two were rechallenged with levodopa/benserazide without symptom recurrence. One patient on oral levodopa/carbidopa developed diarrhea only with intermittent dispersible levodopa/benserazide. 14 were switched to levodopa/carbidopa with resolution of diarrhea in 9 but symptom recurrence in 5. One patient on oral levodopa/benserazide developed profuse diarrhea when switched to levodopa-carbidopa intestinal gel. Of 7/22 patients who had colonoscopy and biopsy, 5 had histopathological proven microscopic colitis.
levodopa/dopa-decarboxylase inhibitor induced microscopic colitis may be more common than previously suspected, with the potential to affect treatment compliance and therapeutic options.
显微镜结肠炎是一种炎症性肠病，其特征为大量非血性水样腹泻。结肠镜检查未见宏观异常，需要活检诊断。少数病例归因于左旋多巴/多巴脱羧酶抑制剂治疗。
对 21 例接受左旋多巴/苄丝肼和 1 例接受左旋多巴-卡比多巴肠凝胶治疗且临床疑似或活检证实为显微镜结肠炎的患者进行回顾性队列研究。
所有 21 例口服左旋多巴/苄丝肼的患者在停止用药后腹泻均得到缓解。4 例患者永久性停用左旋多巴。2 例重新用左旋多巴/苄丝肼治疗，无症状复发。1 例口服左旋多巴/卡比多巴的患者仅在间歇性使用可分散的左旋多巴/苄丝肼时出现腹泻。14 例换用左旋多巴/卡比多巴，9 例腹泻缓解，但 5 例症状复发。1 例口服左旋多巴/苄丝肼的患者换用左旋多巴-卡比多巴肠凝胶后出现大量腹泻。在接受结肠镜检查和活检的 7/22 例患者中，5 例有组织病理学证实的显微镜结肠炎。
左旋多巴/多巴脱羧酶抑制剂引起的显微镜结肠炎可能比以前怀疑的更常见，这可能会影响治疗依从性和治疗选择。
