Ischemic Colitis Secondary to Ergotamine Use: A Case Study

Rodman, Regina; Willson, Thomas D.; Connolly, Mark W.; Podbielski, Francis J.

doi:10.1159/000323681

Cited by 39 publications

(6 citation statements)

References 12 publications

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“…Ischaemic‐pattern colitis has been reported in association with a variety of drugs, including oral contraceptives, ergotamine derivatives, cocaine and, potentially, sumatriptan [a serotonin‐1 5‐hydroxytryptamine (5‐HT 1) receptor agonist] overuse . Rare cases of ischaemic colitis associated with interferon‐alpha (IFN‐α) treatment for chronic hepatitis C (HCV) infection and metastatic cancer have been reported .…”

Section: Ischaemic‐pattern Colitismentioning

confidence: 99%

Iatrogenic pathology of the intestines

2015

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Many drugs and chemical agents can cause enteritis and colitis, producing clinical gastrointestinal side effects, the most common of which are diarrhoea, constipation, nausea and vomiting. Significant histological overlap exists between some patterns of medication or chemical injury and various disease entities. A particular medication may cause multiple patterns of injury and may mimic common entities such as coeliac disease, Crohn's disease, infectious enteritis and colitis. Thus, given the common absence of specific histopathological features, the diagnosis often relies upon thorough clinicopathological correlation. This review concentrates on selected examples of medication-induced injury of the intestinal tract in which the pathology can be recognized, particularly on biopsies, with a focus on newly described medication-induced gastrointestinal effects.

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Section: Ischaemic‐pattern Colitismentioning

confidence: 99%

Iatrogenic pathology of the intestines

2015

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“…This is the sixth case of ischemic colitis due to ergotamine reported in the international literature [23].…”

Section: B Gangrenous Ischemic Colitis (20%)mentioning

confidence: 77%

Untitled

2016

GHOA

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Ergotamine toxicity is rare complication, including tachycardia, arterial spasm, or ischemic colitis which occurring as a result of a treatment with the drug du to different conditions. We report a 54-year-old woman using an ergot-derived drug for migraine. Diagnosis of ergotamine intoxication begins with suspicion. Every doctor and surgeons should be aware of this acute dangerous condition.Keywords: Ischemic colitis; Ergotamine every 100,000 people per year [1]. People affected by this entity are mainly female over 60 years old [2]. However, there are cases reported in young people with no risk factors. Its presentation runs between mild transitory episodes to fulminant colitis that can lead to necrosis, perforation, peritonitis and death. The risk factors identified are high blood pressure, diabetes mellitus, dyslipidemia, coronary disease and drugs, such as NSAIDs, ergotamine, cocaine, antibiotics, cytotoxic drugs and vasoactive agents [3][4][5][6]. Case ReportA 54-year-old female was admitted in the emergency department for 24 hour-longmigraines, diarrhea, lower gastrointestinal bleeding (15 episodes) and left lower abdominal pain. The patient is a former smoker (6 pack/year) with a record of dyslipidemia, thalassemia minor and chronic migraine treated with ergotamine suppositories.Physical examination showed normal vital parameters, abdomen with mild defense and no peritoneal irritation. Traces of blood were found during the rectal examination. ii. Abdominal CT: Irregular wall thickening (>3mm) along the left portion of the large bowel with no compromise of the rectum, pericolic fat stranding, submucosal edema and enhancement of the mucosa after intravenous contrast administration (Figure 1).A complete colonoscopy with previous mechanical bowel preparation was performed. The findings include segmental erythema and areas with pale mucosa from the splenic flexure to the rectosigmoideal junction, with rectal spare. Petechial hemorrhages, haustrations edema and fibrin were also described. Biopsy specimens were obtained.Histologic examination showed epithelium erosion, mucosal and sub mucosal hemorrhage, atrophic crypts and a decrease in the number of caliciform cells. These findings were consistent with ischemic colitis. Conservative treatment was established, with the suppression of the ergotamine suppositories. The patient was discharged 48 hours after admission. No recurrent symptoms were reported. A colonoscopy was performed 6 months after the diagnosis, which showed remission of endoscopic findings (Figure 2).

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“…Ergotamine is an alkaloid derivative from the ergot plant that is used to treat migraine headaches by acting as a 5‐HT 1D receptor agonist causing vasoconstriction . Its vasoactive properties have been associated with cardiac, cerebral, and colonic ischaemic events especially when taken in larger quantities than therapeutically indicated …”

Section: Pharmacologic Agents Moderately Associated With Colon Ischaemiamentioning

confidence: 99%

“…Patients taking any ergotamine medication should have a careful and precise dosing regimen and if they present with symptoms of colonic ischaemia, the drug should be stopped along with any other medications associated with colon ischaemia. Conservative measures will typically yield positive outcomes …”

Section: Pharmacologic Agents Moderately Associated With Colon Ischaemiamentioning

confidence: 99%

Review article: the pharmacological causes of colon ischaemia

Vodusek

Feuerstadt

Brandt

2018

Aliment Pharmacol Ther

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Summary Background Colon ischaemia is the most common ischaemic disorder of the gastrointestinal system, can affect any segment of the colon, and may present with a range of symptoms. Diagnosis can be challenging due to symptom overlap with other conditions, varied aetiology, and often rapid and self‐resolving course. Aim To review comprehensively the literature regarding the pharmacological aetiologies of colonic ischaemia to enhance the understanding of the various mechanisms of disease, presentations, distribution, and outcomes. Methods A PubMed search for “colon ischaemia” and “ischaemic colitis” alone as well as in combination with various known pharmacologic causes was performed. Only the highest quality and relevant literature was included in this review. The quality of the literature for each association was rated by the authors and a consensus was made when discrepancies were encountered. Only associations that were deemed “moderate” or “strong” were included. Results The literature considering pharmacologically associated colonic ischaemia is diverse, lacks codification and is characterised by numerous case reports and case series. Constipation‐inducing drugs, digoxin, hormonal therapies, illicit drugs, immunomodulators, laxatives, and NSAIDs were strongly associated with colonic ischaemia. Antimicrobials, appetite suppressants, chemotherapies, decongestants, diuretics, ergot alkaloids, serotonin agents, statins, and vasopressor agents were moderately associated. Conclusions Patients presenting with abdominal pain, diarrhoea, or bloody stool need to be evaluated for the possibility of this condition and treated accordingly. Timely diagnosis is necessary to improve patient outcomes. This review aims to increase awareness among clinicians regarding the presentation of pharmacologically induced colonic ischaemia.

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Ischemic Colitis Secondary to Ergotamine Use: A Case Study

Cited by 39 publications

References 12 publications

Iatrogenic pathology of the intestines

Iatrogenic pathology of the intestines

Untitled

Review article: the pharmacological causes of colon ischaemia

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