Ulcerative-Obstructive Lesions of the Small Intestine

Nonspecific small bowel ulceration

“…The commonest presenting feature was gastrointestinal haemorrhage, either acute or chronic, but resulting in anaemia. Anaemia was a rare feature in the early reports of this condition (Morgenstern et al, 1965;Billig & Jordan, 1965;Morlock et al, 1956;Lawrason et al, 1965). Later studies suggest that patients with bleeding tend to be younger than those with obstruction (Boydstun et al, 1981;Grosfeld et al, 1970).…”

“…During the 1960s enteric-coated potassium was implicated (Morgenstern et al, 1965;Campbell & Knapp, 1966), and its administration was shown to reproduce such lesions in the dog (Boley et al, 1965). However, in a review of 395 patients from around the world, less than half were taking enteric-coated potassium (Lawrason et al, 1965), and in a recent review from the Mayo Clinic only 10% were receiving such medication (Boydstun et al, 1981). In the present series, none of the patients had received enteric-coated potassium at any time, apart from the one man taking Navidrex-K.…”

“…The lesion was defined by Grasman (1925) as 'sharp-bordered, solitary ulceration with no surrounding inflammation, of unknown cause, indefinite pathogenesis, and an acute or chronic course'. Sporadic case reports have not added a great deal to our understanding ofthese curious ulcers (Boydstun et al, 1981;Watson, 1963;Morgenstern et al, 1965;Alexander & Schwartz, 1966;Billig & Jordan, 1965;Brown & Pemberton, 1936;Evert et al, 1948;Morlock et al, 1956), although enteric-coated potassium tablets have now been identified as one specific cause in certain cases (Morgenstern et al, 1965;Campbell & Knapp, 1966;Dayer et al, 1977).…”

Effects on Upper Gastrointestinal Mucosa of Three Delivery Systems of Potassium as Supplement to Frusemide Administration

“…Until recently, the most widely used preparation in the UK has been a wax matrix slow-release tablet, Slow-KR (Ciba; potassium chloride 600 mg, 8 mEq), which was thought to be safe, and replaced the earlier enteric-coated tablets which were shown to produce gastrointestinal ulceration, haemorrhage and obstruction (Allen et al 1965, Lawrason et al 1965). However, in recent years there have been an increasing number of reports from many countries of the wax matrix tablets causing gastrointestinal ulceration (FarquharsonRoberts et al 1975, McCall 1975, McAvoy 1974, McMahon & Akdamar 1976, Weiss et al 1977, McMahon et al 1983, Lubbe et al 1979, Dayer et al 1977, particularly if the gastrointestinal tract is obstructed or even if motility is slightly impeded (McMahon & Akdamar 1976, Weiss et al 1977, Lowry et al 1975.…”

Diuretics and Adverse Gastrointestinal Reaction

“…Although R oberts [13] in 1961 had already noticed gastrointestinal bleeding in 1 out of 11 patients receiving hydrochlorothiazide and potassium chloride, the etiology of this bleeding was not recognized. Four years passed before several reports on the occur rence of small intestinal ulceration with perforation, bleeding and stenosis, in patients receiving thiazides with supplements of potassium chloride, were published [1,7,10], In a survey including 488 hospitals, small intestinal ulcers were found in 484 cases of whom 275 had been treated with thiazides and potassium salts [6]. In the ensuing studies it was shwon that the ulcerogenic effect was not due to the thiazides themselves but to the rapid release of potassium chloride from enteric-coated tablets and its absorption in high concentration, leading to reduction of blood flow to the mucus membrane [2], Following these reports the administration of potassium in other forms, as well as adequate potassium supply in the food have diminished the incidence of this adverse effect.…”