GASTROENTEROLOGY ARTICLE OF THE MONTH
August 19, 2004
Cappell MS. Colonic toxicity of administered drugs and chemicals. Doi:10.111/j.1572-0241.2004.30192.x
1. Medications that may cause colonic pseudo-obstruction include
a. NSAID’s
b. phenothiazines
c. vincristine
d. neostigmine
e. ipecac
f. verapamil
2. Medication induced colonic ischemia and its suspected mechanism
a. cocaine (vasospasm)
b. estrogens (vasoconstriction)
c. digitalis (shunting blood away from the splanchnic circulation)
d. diuretics (direct injury)
e. kyexalate (hypertonicity)
f. alosetron (stimulation of 5HT1 or 5-HT2 receptors)
g. psudoephedrine (runny nose)
True or False
3. The clinical presentation of medication-induced colonic ischemia is different than “spontaneously” occurring colonic ischemia.
4. Desferoxamine can increase the risk of yersinia enterocolitis by increasing the virulence of the organism.
5. Clonidine may help in the treatment of narcotic-induced colonic pseudo-obstruction.
6. Ampicillin, amoxicillin and erythromycin can cause right-sided hemorrhagic colitis not associated with c. difficile toxin, Klebsiella oxytoca may be involved in the pathogenesis.
7. Typhlitis usually develops with neutrophil count is <100/mm3, affects mainly the sigmoid.
8. Yellow soft plaques in the colon of patients on corticosteroids may represent development of malakoplakia and the histology is diagnostic
9. Gold therapy may be associated with colitis, usually due to a hypersensitivity reaction.
10. NSAID’s but not selective COX-2 inhibitors have been associated with colitis.
11. People who administer themselves detergent, ethyl alcohol, formalin or hydrofluoric acid enemas are in serious need of psychiatric evaluation.