Herbal remedies are the main etiologic factor in melanosis coli, a case series study

Abstract

<jats:title>Abstract</jats:title><jats:p>Melanosis coli is a brown to black discoloration of the colon mucosa usually associated with long-term ingestion of laxatives. However, melanosis coli can be found in patients with no history of laxative use. Regular use of herbal remedies could be the major source of anthranoid laxatives in such patients. We designed a prospective case series study to identify the clinical characteristics and etiology of melanosis coli in affected patients. This study took place in Ankara, Turkey, between 08/2005 and 11/2006. Patients with endoscopic diagnosis of melanosis coli were interviewed for demographical data and use of herbal remedies. A total of 380 colonoscopies were performed during this period. Melanosis coli was diagnosed endoscopically in 12 patients (3.17%), 11 of whom were found to have characteristic pigment-laden macrophages in histopathological examination. Herbal remedies were the main etiological factor in the development of melanosis coli in 10 out of 11 patients. Diffuse involvement was found in 2 patients who had a history of long-term use. In 8 patients, melanosis coli was located in the left side of the colon. Although melanosis coli is a harmless discoloration of colonic mucosa resulting from complementary or alternative medicine, we believe that this association with herbals was overlooked or not inquired in patients. Therefore, it should be emphasized that “natural” or “alternative” is not equal to “safe”.</jats:p>

Chronic California herbal tea use causing biopsy-proven Melanosis coli

“…3 , 7 , 8 But predominant descending colon and rectum involvement as well as diffuse whole-length colonic involvements, were also reported. 4 , 14 Our patient is also found to have diffuse colonic involvement.…”

“…9 Herbal teas containing senna, which are commonly ingested by individuals for their laxative and weight loss effect, are reported to have associations with the development of Melanosis coli . 4 California herbal tea, which is used by our patient, is one of those teas containing senna. 10…”

“… 1 The active ingredients having a laxative effect are also commonly present in natural herbal teas. 4 When the active forms of these laxative molecules pass into the lining of the large bowel, it results in cell damage and death. The dark pigment is then created once the macrophages in the colonic lamina propria are stained by lipofuscin pigment as a result of phagocytosis of apoptotic epithelial cells.…”

Deglycosylated Azithromycin Targets Transgelin to Enhance Intestinal Smooth Muscle Function

“…Some traditional natural medicines, such as rhubarb, senna leaves, and aloe, used to treat constipation contain diarrheal ingredients. Clinical practice has confirmed that the long-term use of rhubarb, senna leaves, and aloe may result in colorectal melanosis, which may induce colorectal cancer development ( Kav and Bayraktar, 2010 ).…”

Bioconcentration and Metabolism of Emodin in Zebrafish Eleutheroembryos

“…Its genotoxicity and DNA-damaging properties also have been found by in-vitro study (Li et al, 2010). Furthermore, many case reports (Han et al, 2010; Kav and Bayraktar, 2010) have shown that chronic use of anthranoid laxatives and weight-loss products may cause melanosis coli (MC), which can increase the risk of colonic neoplasm (van Gorkom et al, 1999). This suggests that the safety of long-term use of emodin should be carefully considered, in agreement with the conclusion from previous studies (Dong et al, 2016).…”