Department of Pathology, Portuguese Institute of Oncology, Porto, Portugal.
Diagnostic and Research Institute of Pathology, Diagnostic and Research Centre for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria.
Virchows Arch. 2022 Nov;481(5):779-783. doi: 10.1007/s00428-022-03351-2. Epub 2022 Jun 2.
Drug-induced injury to the gastrointestinal tract has gained growing significance in recent years, and the list of causative medications keeps expanding. Herein, we present the case of a 45-year-old female with major depressive disorder treated with two serotonin and norepinephrine reuptake inhibitors (venlafaxine and duloxetine). She developed nausea and weight loss. Endoscopic evaluation of the upper and lower gastrointestinal tract rendered grossly normal mucosa in all segments. Histological examination, however, revealed lymphocytic esophagitis, collagenous gastritis, celiac disease-like intraepithelial lymphocytosis of the duodenum, and incomplete collagenous colitis. Gastrointestinal side effects of psychoactive drugs are largely underrecognized. This is the first report of a mixed lymphocytic and collagenous pattern of injury affecting esophagus, stomach, duodenum, and colon triggered by combined treatment with venlafaxine and duloxetine. In patients with unclear symptoms, obtaining biopsies from mucosa that is normal upon endoscopic inspection may render decisive clues for clinical management.
近年来，药物引起的胃肠道损伤越来越受到重视，导致这种损伤的药物种类也在不断增加。本文报道了一位 45 岁女性的病例，她患有重度抑郁症，接受了两种 5-羟色胺和去甲肾上腺素再摄取抑制剂（文拉法辛和度洛西汀）的治疗。她出现了恶心和体重减轻的症状。上消化道和下消化道内镜检查显示所有部位的黏膜大体正常。然而，组织学检查显示淋巴细胞性食管炎、胶原性胃炎、十二指肠类似乳糜泻的上皮内淋巴细胞增多症和不完全性胶原性结肠炎。精神活性药物的胃肠道副作用在很大程度上未被认识。这是首例报告由文拉法辛和度洛西汀联合治疗引起的混合性淋巴细胞和胶原性损伤累及食管、胃、十二指肠和结肠。对于症状不明确的患者，从内镜检查正常的黏膜获取活检可能为临床治疗提供决定性线索。
