Histopathological Changes in the Gastrointestinal Tract Due to Drugs

Abstract

Abnormalities of the gastrointestinal (GI) tract due to drugs (AGIDs) are numerous and have significant impact. The aim of this narrative review is to help the practicing surgical pathologist recognize selected AGIDs. The adverse drug effects presented were chosen with an emphasis on recent and significant pathological and clinical contributions. The selection was based on a thorough review of the PUBMED-based literature and on the authors' opinions and experience. In the first part of the review, diagnostic abnormalities due to crystals (eg, iron, biphosphonates, nonsystemic drugs), mitosis arresting drugs (colchicine, taxanes), and biological agents, especially ipilimumab, are discussed. Some AGIDs' histopathologic features can be easily recognized. It is however the clinical correlation that in many cases of AGIDs will provide the necessary support for a drug effect diagnosis. The identification of AGIDs requires heightened awareness of the medical team in which close collaboration of pathologists and clinicians cannot be overemphasized.

Esophagitis: Old Histologic Concepts and New Thoughts

“…35 Many drugs have been reported to cause mucosal damage (for a review, see Tutuian 35 ); those most commonly implicated are antibiotics (especially of the tetracycline family), nonsteroidal anti-inflammatories, bisphosphonates, slow-release potassium medications, and iron supplements. 36 Biopsies show acute inflammation and ulceration in a nonspecific pattern (Figure 4, A); if pill fragments are identified, this can aid in making a specific diagnosis (Figure 4, B). Sloughing esophagitis may be seen.…”

Gastric siderosis: An under-recognized and rare clinical entity

“…Recently, Marginean et al 2 described three main patterns of iron deposition which include (A) iron deposition in macrophages, stroma and in epithelium; (B) mostly extracellular deposition with some focal deposition in blood vessels, macrophages and epithelium; and finally, (C) mostly in glandular epithelium of antral and fundic cells. 14 In the first two patterns mentioned, the iron was mainly deposited in the surface epithelium, in a focal or patchy distribution. The third pattern showed diffuse, deeply stained iron deposition in the deep gastric glands (foveolar, antral, chief or parietal).…”

“… 2 Iron from ferrous sulfate tablets has a characteristic dark brown, clumpy fibrillary and crystalline appearance. 4 , 6 , 14 Whether granular or fibrillary, both forms of iron deposits are refractile and non-polarizable. 4 , 6 , 14 When stained with Perls’ iron (Prussian blue) stain, hemosiderin deposits appear as fine or clumped deposits, ranging from patchy to diffuse in distribution, and are located in the cytoplasm of stromal and glandular cells with varying intensity ( Figure 3 ).…”

“… 4 , 6 , 14 Whether granular or fibrillary, both forms of iron deposits are refractile and non-polarizable. 4 , 6 , 14 When stained with Perls’ iron (Prussian blue) stain, hemosiderin deposits appear as fine or clumped deposits, ranging from patchy to diffuse in distribution, and are located in the cytoplasm of stromal and glandular cells with varying intensity ( Figure 3 ). 1 , 2 , 14 Histological findings in our second index case appear to be compatible with the pattern described as types A and B, where the deposition is predominantly extracellular, mostly in macrophages and stromal cells, and glandular cells as well ( Figure 4 ).…”

“… 4 , 6 , 14 When stained with Perls’ iron (Prussian blue) stain, hemosiderin deposits appear as fine or clumped deposits, ranging from patchy to diffuse in distribution, and are located in the cytoplasm of stromal and glandular cells with varying intensity ( Figure 3 ). 1 , 2 , 14 Histological findings in our second index case appear to be compatible with the pattern described as types A and B, where the deposition is predominantly extracellular, mostly in macrophages and stromal cells, and glandular cells as well ( Figure 4 ). Mild to moderate non-specific gastric inflammation and mild reactive/regenerative gastropathy may also be found in association; however, H. pylori infection is not usually associated with GS.…”