Endo Katsuya, Yamada Jun, Katayama Tomofumi, Yoshino Yuki, Fukushi Daisuke, Koiwai Akinobu, Kogure Takayuki, Hirota Morihisa, Satoh Kennichi
Department of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan.
DEN Open. 2025 Aug 1;6(1):e70142. doi: 10.1002/deo2.70142. eCollection 2026 Apr.
Direct oral anticoagulants (DOACs), including edoxaban, are widely used for stroke prevention in atrial fibrillation and venous thromboembolism. While gastrointestinal bleeding and diarrhea are recognized adverse effects, DOAC-induced enterocolitis has not been established as a distinct clinical entity. We report the first case of edoxaban-induced enterocolitis in a 75-year-old woman who developed bloody diarrhea and anorexia five days after starting edoxaban. Ileocolonoscopy revealed scattered redness, ulcers, and erosions in the terminal ileum, with diffuse edema and submucosal bleeding from the transverse colon to the rectum. Histopathology showed villous atrophy, lymphatic dilation, and lymphocyte-predominant infiltration in the ileum, along with crypt atrophy, mucosal edema, and hemorrhages in the colon. These findings were inconsistent with infectious, ischemic, vasculitic, or inflammatory bowel diseases, suggesting a drug-induced etiology. Given the acute onset and unique endoscopic and histopathological findings, edoxaban-induced enterocolitis was suspected. The patient's symptoms resolved three days after discontinuing edoxaban, and a follow-up ileocolonoscopy after 3 months showed complete mucosal healing. In accordance with the clinical course, we ultimately diagnosed this case as edoxaban-induced enteritis. Given the widespread use of DOACs, similar cases may be underrecognized, as unexplained bloody diarrhea in these patients often lacks detailed endoscopic evaluation. Further case reports and studies are needed to establish DOAC-induced enteritis as a distinct clinical entity. This case serves as a critical first step in recognizing DOAC-induced enterocolitis and highlights the need for increased awareness among clinicians.
直接口服抗凝剂（DOACs），包括依度沙班，广泛用于预防心房颤动和静脉血栓栓塞中的中风。虽然胃肠道出血和腹泻是公认的不良反应，但DOAC诱发的小肠结肠炎尚未被确立为一种独特的临床实体。我们报告了首例依度沙班诱发小肠结肠炎的病例，患者为一名75岁女性，在开始服用依度沙班五天后出现血性腹泻和厌食。回结肠镜检查显示回肠末端有散在的发红、溃疡和糜烂，从横结肠到直肠有弥漫性水肿和黏膜下出血。组织病理学显示回肠绒毛萎缩、淋巴管扩张和以淋巴细胞为主的浸润，同时结肠有隐窝萎缩、黏膜水肿和出血。这些发现与感染性、缺血性、血管炎性或炎症性肠病不符，提示药物性病因。鉴于急性起病以及独特的内镜和组织病理学表现，怀疑为依度沙班诱发的小肠结肠炎。停用依度沙班三天后患者症状缓解，3个月后的随访回结肠镜检查显示黏膜完全愈合。根据临床病程，我们最终将该病例诊断为依度沙班诱发的肠炎。鉴于DOACs的广泛使用，类似病例可能未得到充分认识，因为这些患者中无法解释的血性腹泻往往缺乏详细的内镜评估。需要进一步的病例报告和研究来将DOAC诱发的肠炎确立为一种独特的临床实体。该病例是认识DOAC诱发的小肠结肠炎的关键第一步，并强调了临床医生提高认识的必要性。
