Kayexalate-Induced Colonic Pseudotumor

Chatila, Ahmed; Bilal, Mohammad; Merwat, Sheharyar

doi:10.1016/j.cgh.2018.03.032

Cited by 10 publications

(8 citation statements)

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“…SPS-induced colonic pseudotumors have been described. In all cases, the biopsies were negative for dysplasia with only SPS crystals and inflammation identified [4,5,15].…”

Section: Discussionmentioning

confidence: 95%

“…SPS is usually administered combined with sorbitol, a hypertonic agent that accelerates the transit through the small intestine and reduces the risk of obstruction and impaction. e colon is most commonly affected because sorbitol is metabolized by the normal microbiota, and mucosa is exposed longer to the resin, which may induce mucosal ischemia [5,[9][10][11]. Several direct and indirect mechanisms by which SPS may cause mucosal injury have been identified [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…e colon is most commonly affected because sorbitol is metabolized by the normal microbiota, and mucosa is exposed longer to the resin, which may induce mucosal ischemia [5,[9][10][11]. Several direct and indirect mechanisms by which SPS may cause mucosal injury have been identified [4][5][6]. When the resin is in prolonged direct contact with the gastrointestinal lumen, an acute inflammatory response can occur in the epithelium [4].…”

Section: Discussionmentioning

confidence: 99%

“…e crystals directly elicit an area of inflammation usually after 24 hours of direct exposure. When SPS is administered with sorbitol as a combined formulation, sorbitol may cause a direct toxic effect by direct local prostaglandin activity in the site [4,5]. Prolonged stasis of crystals in the lumen has the potential of developing erosions and ultimately necrosis [6].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with prolonged use of potassium-binding resins who have chronic constipation or a mechanical obstruction may develop colonic necrosis due to long exposure of the resin to mucosa. Usually, the endoscopic lesions are ulcerations and erosions, although a few case reports have documented mass-like lesions in the colon mimicking malignancy [4,5]. Well-known risk factors for GI complications are uremia, end-stage renal disease, hemodynamic instability, kidney transplantation, gastrointestinal surgery, and constipation [3].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Esophageal Pseudotumor Secondary to Treatment with a Potassium Binder Resin: A Case of Severe Esophagitis Mimicking a Malignancy

Chavez

Bustamante-Bernal

Padilla

et al. 2022

Case Reports in Gastrointestinal Medicine

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Background. Sodium polystyrene sulfonate is a resin used to treat hyperkalemia. Colonic mucosal injury, intestinal ischemia, necrosis, and perforation have been widely reported in the literature, but few cases have reported upper gastrointestinal injury and identify the endoscopic features. Case Presentation. We describe a case of an 83-year-old male, with no prior esophageal symptoms, who developed dysphagia after being treated with sodium polystyrene sulfonate for hyperkalemia. Endoscopic features consistent with severe esophagitis and a mass in the lower esophagus mimicking a malignancy were found, and pathology confirmed resin-induced esophagitis. Discussion. The identification of basophilic crystals in the epithelium with surrounding inflammation is a hallmark of sodium polystyrene sulfonate-induced mucosal injury. Several direct and indirect mechanisms by which SPS may cause mucosal injury have been identified. Prolonged stasis of crystals in the lumen has the potential of developing erosions and ultimately necrosis. The internalization of these crystals to the underlying intestinal mucosa with the combination of the inflammatory response may give an appearance of a luminal mass that can mimic a malignancy. Recognizing the wide-ranging endoscopic findings of resin-induced mucosal injury in the esophagus is fundamental to consider a potential side effect of sodium polystyrene sulfonate. The use of this resin should be avoided in patients with suspected esophageal motility disorder.

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“…SPS-induced colonic pseudotumors have been described. In all cases, the biopsies were negative for dysplasia with only SPS crystals and inflammation identified [4,5,15].…”

Section: Discussionmentioning

confidence: 95%