Diaphragmatic disease of the colon: systematic review

Munipalle, P C; Garud, T; Light, Duncan

doi:10.1111/codi.12218

Cited by 18 publications

(18 citation statements)

References 37 publications

(28 reference statements)

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“…The amount of diclofenac that the patient had used, as well as the duration of the drug use account for the biological gradient (the presence of a dose-response relationship) and the temporality, as previously stated by Aftab et al 6 . Finally, the recovery of the eroded colonic mucosa after cessation of diclofenac acts as experimental evidence, in accordance with the suggestion that trial cessation of the NSAIDs should be implemented in the presence of colonic diaphragms 1 . One of the most frequent tools used in adverse drug reaction assessment is the Naranjo probability scale, featuring a list of weighted questions related to the presence of previous reports on a specific reaction, the temporal relationship between the drug and the effect, alternative causes for the event, previous reactions to the same drug, as well as the drug dosage.…”

Section: Discussionsupporting

confidence: 77%

“…These viewpoints are regarded as criteria for identifying causality in clinical practice even beyond epidemiological studies 10 . Despite the fact that NSAID-induced colopathy is a rare event (yielding a small number of reports in the literature), the systematic review by Munipalle et al provided an optimistic basis for future research on the strength of association between NSAID use and colonic lesions 1 . The existence of several case reports and case series (which have been referenced in this paper) account for the consistency of this association, while the plausibility and coherence can be estimated with the knowledge of NSAID metabolism, despite the fact that the pathophysiology of colopathy is not yet fully understood.…”

Section: Discussionmentioning

confidence: 99%

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Nonsteroidal anti-inflammatory drug-induced colopathy: An uncommon cause of positive immunochemical faecal occult blood test in the program for colorectal cancer screening

et al. 2021

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Introduction. Nonsteroidal anti-inflammatory drug-induced colopathy is an uncommon condition associated with the long-term use of enteric-coated and slow-release nonsteroidal anti-inflammatory drugs. This paper presents such a case of colopathy showing no symptoms or signs, which discovered by a positive immunochemical faecal occult blood test. Case report. Performed within the framework of the National Program for Screening of Colorectal Cancer, a immunochemical faecal occult blood test was positive in 56-yearsold female patient. The colonoscopy revealed three lesions in the right colon: one erosionulceration and two concentric "diaphragm-like" strictures passable by the endoscope. The patient reported that she had been taking diclofenac 100 mg twice daily for the past seven years. After withdrawal of the offending drug, the second colonoscopy indicated marked improvement in the colonic mucosa while the "diaphragm-like" strictures persisted. Conclusion. The cases of nonsteroidal anti-inflammatory drug-induced colopathy are likely to become more frequent. It would therefore be advisable to take long-term use of such drugs into consideration as being a possible factor that leads to mucosal injury, particularly in the right colon, as well as their being a rare reason for a positive immunochemical faecal occult blood test.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Nonsteroidal anti-inflammatory drug-induced colopathy: An uncommon cause of positive immunochemical faecal occult blood test in the program for colorectal cancer screening

et al. 2021

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“…Recently, with the increasing use of slow-release and enteric-coated NSAIDs that allow more drugs to reach the colon, their influence has come to the attention of researchers. In a systematic review that analysed 45 patients diagnosed with an NSAID-induced colopathy, Munipalle et al [5] reported diclofenac as the causative agent in most of these cases, wherein the median usage of NSAIDs was 5 years. As the gut has a narrow set of responses, the outcome is inflammation, ulceration, and the formation of fibrous diaphragm-like strictures as a result of healing [6].…”

Section: Discussionmentioning

confidence: 99%

Nonsteroidal Anti-Inflammatory Drug-Induced Colopathy in a Colorectal Cancer Screening Program

2018

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Objective: To present a case of colopathy related to the use of diclofenac in a patient with a positive immunochemical faecal occult blood test (iFOBT) and to discuss the influence of nonsteroidal anti-inflammatory drugs (NSAIDs) on iFOBT specificity. Clinical Presentation and Intervention: A colonoscopy in a 56-year-old female presenting with a positive iFOBT revealed diaphragm-like strictures and ulcers in the right colon. While carrying out a detailed retrospective interview, she reported a chronic backache requiring long-term NSAID treatment. Conclusion: No association has been established between chronic use of NSAID and a false-positive iFOBT. There is no need to stop NSAIDs before performing an iFOBT in a colorectal cancer screening program.

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“…Originally described in terminal ileum, 4 it has also been reported in right colon. 5 The diagnosis is straightforward on endoscopy and gross examinations of resected specimens. Histologically, elongated plicae (diaphragms) with submucosal fibrosis are seen, often eroded at the tip.…”

Section: Most Common Drug-induced Histologic Patterns Of Injury In Comentioning

confidence: 99%

The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract

Marginean

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.—There is an ever-growing armamentarium of pharmacologic agents that can cause gastrointestinal (GI) mucosal injury, the most common symptoms being diarrhea, constipation, nausea, and vomiting. These are often self-limiting and without serious sequelae, but some symptoms are of greater concern, like drug-induced mucosal ulceration that can manifest as GI hemorrhage, stricture formation, and even perforation. Histologically, there is significant overlap between drug-induced injuries and various disease entities. A single type of medication may cause multiple patterns of injury, which can involve the entire GI tract or just some parts of it. Objective.—To review the most common drug-induced injury patterns affecting the colon, which may be recognized by the surgical pathologist on colonic mucosal biopsies. This review does not address the injuries occurring in the upper GI tract. Data Sources.—A PubMed review of English-language literature, up to December 2015, on drug-induced injury of GI tract was performed. Conclusions.—There are numerous drugs that damage the colonic mucosa. The most common drugs are included in this review according to their histologic pattern of injury. It is important for the pathologist to keep in mind that a single drug type can induce many histologic patterns of mucosal injury that can mimic many disease entities. Although there are some histologic clues helpful in the diagnosis of drug-induced colonic injury, correlation with clinical history and especially medication history is essential to improve diagnostic accuracy.

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Diaphragmatic disease of the colon: systematic review

Cited by 18 publications

References 37 publications

Nonsteroidal anti-inflammatory drug-induced colopathy: An uncommon cause of positive immunochemical faecal occult blood test in the program for colorectal cancer screening

Nonsteroidal anti-inflammatory drug-induced colopathy: An uncommon cause of positive immunochemical faecal occult blood test in the program for colorectal cancer screening

Nonsteroidal Anti-Inflammatory Drug-Induced Colopathy in a Colorectal Cancer Screening Program

The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract

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