Drug-Related Enteropathy

Abstract

Over 700 drugs have been implicated as cause of chronic diarrhea and potential enteral damage. Pathophysiologic mechanisms include intrinsic malabsorption as their main mode of action (i.e., acarbose or orlistat), increased risk of microscopic colitis/enteritis (proton-pump inhibitors (PPI), non-steroidal anti-inflammatory drugs (NSAID), selective serotonin reuptake inhibitors (SSRI)), dysbiosis (antibiotics, metformin, PPI), and microscopic or overt enteropathy (angiotensin inhibitors, antineoplastic agents, targeted therapy and check-point inhibitors). According to type, diarrhea can be malabsorptive, inflammatory or mixed, and may affect different portions of small intestine, colon, or both. Drug-induced enteropathy ranges from asymptomatic histological changes to macroscopic damage similar to that seen in inflammatory bowel disease. Treatment may include discontinuation of drug, correction of dysbiosis, and in severe cases, directed therapy towards intestinal wall inflammatory states, in similar mode as in other inflammatory bowel diseases.

Chronic use of proton pump inhibitors and vitamin B12 deficiency: Current evidence and recommendations

“…As PPIs have become more popular and more widely used, there has been an increase in the emergence of potentially adverse effects related to them (Elias;Targownik, 2019) with studies relating them to chronic kidney disease, bone fractures, pneumonia, dementia to, more recently, COVID-19, although the mechanisms and causalities of these relationships have not been pointed out (Targownik et al, 2022). Among these effects, the intestinal alterations evoked by the prolonged use of PPIs, such as mucosal damage and alteration of the microbiota, with consequent impact on nutrient absorption and the response of the immune barrier system and, finally, on the general health of the patient, have gained a lot of attention from researchers in recent years, however, research involving this theme presents conflicting and unclear results (Gómez-Escudero, 2023).…”