International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2014, 2(2), 49-53
DOI: 10.12691/ijcd-2-2-5
Open AccessSTATE OF THE ART

Drug-induced Sprue-like Intestinal Disease

Hugh James Freeman1,

1Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, Canada

Pub. Date: May 05, 2014

Cite this paper:
Hugh James Freeman. Drug-induced Sprue-like Intestinal Disease. International Journal of Celiac Disease. 2014; 2(2):49-53. doi: 10.12691/ijcd-2-2-5

Abstract

Celiac disease is a gluten-dependent small intestinal disorder with characteristic, but non-specific histopathological features. A number of disorders may cause similar changes in small intestinal biopsies, but fail to respond to a gluten-free diet. Traditionally, infectious agents, such as giardiasis, were often believed to be responsible, but in many patients with a sprue-like intestinal disorder, other causes were detected. The list continues to expand with the emergence of “new” diseases, including transplant enteropathy, distinct immune deficiency syndromes and postcolectomy enteritis, as well as new treatments. Many medications may cause a sprue-like small intestinal mucosal inflammatory process. Alcohol, antibiotics (eg., neomycin), non-steroidal anti-inflammatory drugs (eg., sulindac), stathmokinetic and chemotherapeutic agents (eg., colchicine, vincristine, methotrexate) and immunosuppressive medications (eg., azathioprine, mycophenolate mofetil) may all cause sprue-like small intestinal mucosal changes. A number of “new” drugs have also been recently recognized to cause a sprue-like intestinal disease. These include pharmaceuticals, such as olmesartan, an angiotensin II receptor antagonist used in treatment of hypertension, and biologicals, specifically ipilimumab, a humanized monoclonal antibody designed to overcome cytotoxic T-lymphocyte antigen-4, used in treatment of some advanced malignancies, including malignant melanoma. Increased physician awareness for medication-related sprue-like intestinal disease is critical as the list of emerging and novel medications expands.

Keywords:
celiac disease sprue-like intestinal disease sprue-like enteropathy unclassified sprue drug-induced small intestinal disease post-colectomy enteritis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Freeman HJ, Chopra A, , Recent advances in celiac disease. World J Gastroenterol 2011; 17: 2259-2272.
 
[2]  Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 2012; 18: 6036-6059.
 
[3]  Freeman HJ. Pearls and pitfalls in the diagnosis of adult celiac disease. Can J Gastroenterol 2008; 22: 273-280.
 
[4]  MacDonald WC, Brandborg LL, Flick AL, Trier JS, Rubin CE. Studies of celiac sprue. IV. The response of the whole length of the small intestine to a gluten-free diet. Gastroenterology 1964; 47: 573-589.
 
[5]  Tursi A, Brandimarte G, Giorgetti GM, Elisei W, Inchingolo CD, Monardo E, Aiello F. Endoscopic and histologic findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study. Endoscopy 2006; 38: 702-707.
 
[6]  Freeman HJ. Sprue-like intestinal disease. International Journal of Celiac Disease 2014; 2: 6-10.
 
[7]  Marcos LA, Gotuzzo E. Intestinal protozoan infections in the immunocompromised host. Curr Opin Infect Dis 2013; 26: 295-301.
 
[8]  Washington K, Stenzel TT, Buckley RH, Gottfried MR. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol 1996; 20: 1240-1252.
 
[9]  Agarwal S, Mayer L. Diagnosis and treatment of gastrointestinal disorders in patients with primary immunodeficiency. Clin Gastroenterol Hepatol 2013; 11: 1050-1063.
 
[10]  Gooding IR, Springall R, Talbot IC, Silk DB. Idiopathic small intestinal inflammation after colectomy for ulcerative colitis. Clin Gastroenterol Hepatol 2008; 6: 707-709.
 
[11]  Rosenfeld G, Freeman HJ, Brown M, Steinbrecher UP. Severe and extensive enteritis following colectomy for ulcerative colitis. Can J Gastroenterol 2012; 26: 866-867.
 
[12]  Robinson JW. Intestinal malabsorption in the experimental animal. Gut 1972; 13: 938-945.
 
[13]  Wilson FA, Hoyumpa AM Jr. Ethanol and small intestinal transport. Gastroenterology 1979; 76: 388-403.
 
[14]  Longstreth GF, Newcomer AD. Drug-induced malabsorption. Mayo Clin Proc 1975; 50: 284-293.
 
[15]  Jacobson ED, Prior JT, Faloon WW. Malabsorptive syndrome induced by neomycin: morphologic alterations in the jejunal mucosa. J Lab Clin Med 1960; 56: 245-250.
 
[16]  Race TF, Paes IC, Faloon WW. Intestinal malabsorption induced by oral colchicine. Comparison with neomycin and cathartic agents. Am J Med Sci 1970; 259: 32-41.
 
[17]  Wright N, Watson A, Morley A, Appleton D, Marks J, Douglas A. The cell cycle time in the flat (avillous) mucosa of the human small intestine. Gut 1973; 14: 603-606.
 
[18]  Trier JS. Morphologic alterations induced by methotrexate in the mucosa of the human proximal intestine. 1. Serial observations by light microscopy. Gastroenterology 1962; 42: 295-305.
 
[19]  Roche AC, Bognel JC, Bognel C, Bernier JJ. Correlation between the histological changes and glucose intestinal absorption following a single dose of 5 fluorouracil. Digestion 1970; 3: 195-212.
 
[20]  Freeman HJ. Sulindac associated small bowel lesion. J Clin Gastroenterol 1986; 8: 569-571.
 
[21]  Ziegler TR, Fernandez-Estivariz C, Gu LH, Fried MW, Leader LM. Severe villous atrophy and chronic malabsorption induced by azothioprine. Gastroenterology 2003; 124: 1950-1957.
 
[22]  Ducloux D, Ottignon Y, Semhoun-Ducloux S, Labbe S, Saint-Hillier Y, Miguet JP, Carayon P, Chalopin JM. Mycophenolate mofetil-induced villous atrophy. Transplantation 1998; 66: 1115-1116.
 
[23]  Kamar N, Faure P, Dupuis E, Cointault O, Joseph-Hein K, Durand D, Moreau J, Rostaing L. Villous atrophy induced by mycophenolate mofetil in renal-transplant patients. Transpl Int 2004; 17: 463-467.
 
[24]  Tapia O, Villaseca M, Sierralta A, Roa JC. Duodenal villous atrophy associated with Mycophenolate mofetil: report of one case. Rev Med Chil 2010; 138: 590-594.
 
[25]  Parfitt JR, Jayakumar S. Driman DK. Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes. Am J Surg Pathol 2008; 32: 1367-1372.
 
[26]  Freeman HJ. Collagenous mucosal inflammatory diseases of the gastrointestinal tract. Gastroenterology 2005; 129: 338-350.
 
[27]  Freeman HJ. Long-term natural history and complications of collagenous colitis. Can J Gastroenterol 2012; 26: 627-630.
 
[28]  Rubio-Tapia A, Herman ML, Ludvigsson JF, et al. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 2012; 87: 732-738.
 
[29]  Tran TH, Li H. Olmesartan and drug-induced enteropathy. PT 2014; 39: 47-38.
 
[30]  Dreifuss SE, Tomizawa Y, Farber NJ, Davison JM, Sohnen AE. Spruelike enteropathy associated with olmesartan: an unusual case of severe diarrhea. Case Rep Gastrointest Med 2013; 2013: 618071.
 
[31]  Nielsen JA, Steephen A, Lewin M. Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug. World J Gastroenterol 2013; 19: 6928-6930.
 
[32]  DeGaetani M, Tennyson CA, Lebwohl B, Lewis SK, Abu Daya H, Arguelles-Grande C, Bhagat G, Green PH. Villous atrophy and negative celiac serology: a diagnostic and therapeutic dilemma. Am J Gastroenterol 2013; 108: 647-653.
 
[33]  Freeman HJ. Colitis associated with biological agents. World J Gastroenterol 2012; 18: 1871-1874.
 
[34]  Gentile NM, D’Souza A, Fujii LL, Wu TT, Murray JA. Association between ipilimumab and celiac disease. Mayo Clin Proc 2013; 88: 414-417.