Sites of gastrointestinal lesion induced by mycophenolate mofetil: a comparison with enteric-coated mycophenolate sodium in rats

Jia, Yichen; Wang, Rulin; Li, Long; Zhang, Ying; Li, Jiawei; Wang, Jina; Wang, Xuanchuan; Qi, Guisheng; Rong, Ruiming; Xu, Ming; Zhu, Tongyu

doi:10.1186/s40360-018-0234-1

Cited by 6 publications

(2 citation statements)

References 34 publications

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“…In 40-50% of patients, GI intolerance of MMF is the leading cause of dosage changes and interruptions or discontinuations of immunosuppressive therapy [13]. The incidence of MPA-related GI adverse effects varies from 45 to 80% [13][14][15][16]. Common GI symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, anorexia, ulcers, and dyspepsia [4,17], among which diarrhea is most frequently reported the adverse effect [5].…”

Section: Discussionmentioning

confidence: 99%

Giant Gastric Ulcers: An Unusual Culprit

et al. 2020

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Mycophenolate Mofetil (MMF) is routinely used immunosuppressant in solid organ transplantation is commonly associated with several gastrointestinal (GI) side effects. Here we present a case of giant gastric ulcer of 5 cm from MMF use post cardiac transplant. Case Description A 56-year-old male with history of severe ischemic cardiomyopathy post heart transplant was on immunosuppression with MMF, tacrolimus and prednisone for 5 months. He presented with severe epigastric pain and intermittent episodes of melena for 1 month. His pain radiated to back that is worsened with eating. Associated with loss of appetite, vomiting and 16-pound weight loss in 3 months. He never smoked, drank alcohol or used over the counter pain medications. He was profoundly anemic requiring blood transfusions. EGD performed demonstrated very large clean-based ulcer of 5 cm diameter in the body, smaller ulcer of 8 mm diameter in pre-pyloric region and 5-10 small aphthous ulcers in the gastric body and fundus. Gastric biopsies taken from the ulcer were negative for Helicobacter pylori, cytomegalovirus and malignancy. Flexible sigmoidoscopy revealed non-bleeding inflamed internal hemorrhoids. Consequently, MMF was discontinued and switched to azathioprine. He was treated with twice daily proton pump inhibitor therapy with resolution of abdominal pain, improved appetite and weight gain. Discussion MMF is well known for common GI side-effects such as nausea, diarrhea, vomiting, ulcers, abdominal pain and rarely gastrointestinal bleeding. Few studies reported 3 to 8% incidence of ulcer perforation and GI bleeding within 6 months. Risk of gastroduodenal erosions is nearly 1.83 times for MMF, with the highest lesions associated with MMFtacrolimus-corticosteroid combination treatment as seen in our patient. Hypothesis is that GI tract is vulnerable because of dependence of enterocytes on de novo synthesis of purines, which is disrupted by MMF. Typically, upper GI mucosal injuries of mucosal irritation leading to esophagitis, gastritis and/or ulcers are seen. Endoscopy is both diagnostic and therapeutic if bleeding gastric ulcers are noted. Minor complications improve with reduction of drug dose or use of enteric coated preparation if feasible. Discontinuation of the drug is main stay in the management of MMF related ulcer disease. Simple medical treatment with either H2-receptor antagonists, proton-pump inhibitors, coating agents, prostaglandins or combination has proven effective in most cases. Considering excellent results with medical management of ulcer, role of surgery is limited.

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Section: Discussionmentioning

confidence: 99%

Giant Gastric Ulcers: An Unusual Culprit

et al. 2020

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“…In addition, MMF cause dose-dependent gastrointestinal (GI) side effects, including ulcers, diarrhea, and nausea [ 70 ]. Enteric-coated mycophenolate sodium (EC-MPS), a delayed-release formulation, improves GI tolerability [ 71 , 72 ].…”

Section: Managementmentioning

confidence: 99%

Recent advances in graves ophthalmopathy medical therapy: a comprehensive literature review

Fan

et al. 2022

Int Ophthalmol

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Graves ophthalmopathy (GO), which occurs in autoimmune thyroid disease, can reduce patients’ quality of life due to its impact on visual function, physical appearance, and emotional health. Corticosteroids have been the first-line treatment for GO. More recently, the pathogenesis of GO has made significant progress. Various targeting biological agents and immunosuppressive agents make GO management more promising. Fully understanding GO pathogenesis and precise clinical management are beneficial for the prognosis of patients. Therefore, we conducted a comprehensive review of the medical management of GO and summarized research developments to highlight future research issues.

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Determination and validation of mycophenolic acid by a UPLC-MS/MS method: Applications to pharmacokinetics and tongue tissue distribution studies in rats

Gao

Tsai

et al. 2020

Journal of Chromatography B

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Sites of gastrointestinal lesion induced by mycophenolate mofetil: a comparison with enteric-coated mycophenolate sodium in rats

Cited by 6 publications

References 34 publications

Giant Gastric Ulcers: An Unusual Culprit

Giant Gastric Ulcers: An Unusual Culprit

Recent advances in graves ophthalmopathy medical therapy: a comprehensive literature review

Determination and validation of mycophenolic acid by a UPLC-MS/MS method: Applications to pharmacokinetics and tongue tissue distribution studies in rats

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