Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Lawrence, KS, USA.
Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA.
Aliment Pharmacol Ther. 2021 Dec;54(11-12):1370-1388. doi: 10.1111/apt.16642. Epub 2021 Oct 20.
Drug-induced gastrointestinal injury has been increasingly reported, but its exact incidence is not known. The small and large intestines represent the most affected sites of injury, accounting for 20%-40% of all gastrointestinal side effects.
To provide an updated literature review detailing medications linked to the development of small bowel injury.
We conducted a literature search on PubMed from its inception to May 1, 2021. We included English-language original studies, meta-analyses, systematic reviews, review articles and case reports.
Drug-induced enteropathy can range from asymptomatic histological changes resulting in a subtle, self-limited disease to a chronic inflammatory condition mimicking inflammatory bowel disease, or bowel perforation. Endoscopy can demonstrate erythema, mucosal friability, oedema, erosions, ulcers or strictures in severe cases. Histology may include mucosal erosions and ulcerations, focal active enteritis, villous atrophy, epithelial apoptosis or necrotising enteritis. A well-established association has been found with the use of nonsteroidal anti-inflammatory drugs, immunosuppressants, chemotherapeutic agents, antibiotics, immunotherapies, etanercept and olmesartan. Possible associations have been reported with other biologic agents, medications used for glycemic control, antihypertensives, cholinesterase inhibitors, potassium and iron supplements, with conflicting data regarding contraceptives/hormonal therapy and isotretinoin.
Physicians should be aware of the manifestations of drug-induced enteropathy as early recognition can lead to prompt discontinuation of the offending therapy and, therefore, a reduced risk of future complications.
药物引起的胃肠道损伤的报道越来越多，但确切的发病率尚不清楚。小肠和大肠是最易受损伤的部位，占所有胃肠道副作用的 20%-40%。
提供一篇更新的文献综述，详细介绍与小肠损伤相关的药物。
我们对 PubMed 从成立到 2021 年 5 月 1 日进行了文献检索。我们纳入了英语原创研究、荟萃分析、系统评价、综述文章和病例报告。
药物性肠病的范围从无症状的组织学改变导致轻微、自限性疾病到类似于炎症性肠病的慢性炎症状态，甚至肠穿孔。内镜检查可在严重病例中显示红斑、黏膜易碎、水肿、糜烂、溃疡或狭窄。组织学可能包括黏膜糜烂和溃疡、局灶性活动性肠炎、绒毛萎缩、上皮细胞凋亡或坏死性肠炎。已发现与非甾体抗炎药、免疫抑制剂、化疗药物、抗生素、免疫疗法、依那西普和奥美沙坦的使用有明确的相关性。还报道了与其他生物制剂、用于血糖控制的药物、降压药、胆碱酯酶抑制剂、钾和铁补充剂的可能相关性，而关于避孕药/激素治疗和异维 A 酸的数据则存在冲突。
医生应该意识到药物性肠病的表现，因为早期识别可以导致及时停止引起损伤的治疗，从而降低未来并发症的风险。
