Copyright
©The Author(s) 2019.
World J Gastroenterol. Feb 28, 2019; 25(8): 967-979
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.967
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.967
Table 1 Basic demographic characteristics n (%)
Drug-induced colitis, n = 211 | Non-inflammatory controls, n = 211 | Inflammatory controls, n = 211 | |
Basic characteristics | |||
Age (yr) | 62.3 ± 16.4 | 62.2 ± 16.3 | 61.8 ±15.7 |
Gender (male) | 97 (46.0) | 97 (46.0) | 97 (46.0) |
Height (cm) | 168.9 ± 9.5 | 168.3 ± 12.4 | 170.0 ± 9.3 |
Body weight (kg) | 76.9 ± 22.6 | 75.0 ± 20.3 | 72.9 ± 19.7 |
BMI (kg/m2) | 26.9 ± 7.2a1b | 26.3 ± 6.8 | 25.0 ± 5.6a3 |
ASAb2 | |||
ASA 1 | 0 (0) | 3 (1.4) | 0 (0) |
ASA 2 | 133 (63.0) | 169 (80.1) | 155 (73.5) |
ASA 3 | 70 (33.2) | 37 (17.5) | 52 (24.6) |
ASA 4 | 8 (3.8) | 2 (0.9) | 4 (1.9) |
ECOGb2,b3 | |||
ECOG 0 | 0 (0) | 1 (0.5) | 2 (0.9) |
ECOG 1 | 8 (3.8) | 75 (35.5) | 13 (6.2) |
ECOG 2 | 149 (70.6) | 104 (49.3) | 147 (69.7) |
ECOG 3 | 41 (19.4) | 26 (12.3) | 43 (20.4) |
ECOG 4 | 13 (6.2) | 5 (2.4) | 6 (2.8) |
Indication of colonoscopyb1,a2 | |||
Diarrhoea | 73 (34.6) | 95 (45.0) | 97 (46.0) |
Constipation | 6 (2.8) | 5 (2.4) | 1 (0.5) |
Gastrointestinal bleeding | 63 (29.9) | 31 (14.6) | 36 (17.1) |
Abdominal pain | 47 (22.3) | 54 (25.6) | 46 (21.8) |
Weight loss | 6 (2.8) | 5 (2.4) | 4 (1.9) |
Scheduled survey | 2 (0.9) | 1 (0.5) | 2 (0.9) |
Miscellaneous | 14 (6.6) | 20 (9.5) | 25 (11.8) |
Table 2 Comorbidities n (%)
Comorbidity | Drug-induced colitis, n = 211 | Non-inflammatory controls, n = 211 | Inflammatory controls, n = 211 |
Pulmonary | 39 (18.5) | 31 (14.7) | 37 (17.5) |
Cardiac | 110 (52.1) | 93 (44.1) | 87 (41.2) |
Neurological | 27 (12.8) | 23 (10.9) | 19 (9.0) |
Psychiatric | 10 (4.7) | 9 (4.3) | 10 (4.7) |
Endocrine | 47 (22.3) | 44 (20.9) | 30 (14.2) |
Renal | 28 (13.2) | 18 (8.5) | 21 (10.0) |
Hepatic | 11 (5.2) | 13 (6.2) | 11 (5.2) |
Oncological | 14 (6.6) | 25 (11.8) | 17 (8.1) |
Other | 19 (9.0) | 15 (7.1) | 16 (7.6) |
Heart failure | 35 (16.6) | 16 (7.6)b2 | 31 (14.7)a3 |
Renal insufficiency | 24 (11.4) | 14 (6.6) | 18 (8.5) |
Atrial fibrillation | 26 (12.3) | 18 (8.5) | 22 (10.4) |
Coronary heart disease | 47 (22.3) | 28 (13.3)a2 | 35 (16.6) |
Peripheral arterial occlusive disease | 7 (3.3) | 10 (4.7) | 11 (5.2) |
Atherosclerosis | 74 (35.1)b1 | 39 (18.5)b2 | 40 (19.0) |
Arterial hypertension | 98 (46.4) | 97 (46.0) | 87 (41.2) |
Diabetes mellitus | 46 (21.8) | 45 (21.3) | 32 (15.2) |
Hypercholesterinaemia | 20 (9.5) | 16 (7.6) | 18 (8.5) |
Hyperlipoproteinaemia | 22 (10.4)a1 | 11 (5.2)a2 | 9 (4.3) |
Chronic obstructive lung disease | 29 (13.7) | 24 (11.4) | 27 (12.8) |
Stroke | 14 (6.6) | 9 (4.3) | 11 (5.2) |
Smoking | 77 (36.7) | 66 (31.3) | 78 (37.0) |
Surgery | 9 (4.3) | 1 (0.5)a2 | 3 (1.4) |
Intensive care therapy | 9 (4.3) | 2 (0.9)a2 | 4 (3.1) |
Table 3 Histopathological reassessment n (%)
Parameter (n = 28) | Drug-induced colitis without atherosclerosis | Drug-induced colitis with atherosclerosis | Ischaemiccolitis |
Oedema | 2 (7.1) | 2 (7.1) | 4 (14.3) |
Haemorrhage | 1 (3.6)a2 | 8 (28.6)a1 | 6 (21.4) |
Lymphocytic infiltration | 27 (96.4) | 27 (96.4) | 27 (96.4) |
Granulocytic infiltration | 27 (96.4) | 26 (92.9) | 28 (100.0) |
Eosinophilic infiltration | 12 (42.9)b2 | 7 (25.0) | 1 (3.6)a3 |
Erosions | 2 (7.1)b2 | 9 (32.1)a1 | 10 (35.7) |
Ulcerous lesions | 4 (14.3)b2 | 3 (10.7) | 16 (57.1)b3 |
Necrosis | 1 (3.6)b2 | 1 (3.6) | 16 (57.1)b3 |
Fibrin plaques on erosions | 2 (7.1) | 2 (7.1) | 3 (10.7) |
Fibrosis | 3 (10.7) | 3 (10.7) | 7 (25.0) |
Table 4 Drug assessment n (%)
Group | Drug-induced colitis, n = 211 | Non-inflammatory controls, n = 211 | Inflammatory controls, n = 211 |
Betablocker | 97 (46.0) | 78 (37.0) | 83 (39.3) |
ACE inhibitors | 70 (33.2) | 55 (26.1) | 62 (29.4) |
Angiotensin II inhibitors | 20 (9.5)b1 | 24 (11.4) | 6 (2.8)b3 |
Non-Dihydropyridines | 1 (0.5)a1 | 6 (2.8) | 7 (3.3) |
Dihydropyridines | 34 (16.1)a1 | 27 (12.8) | 20 (9.5) |
Diuretics | 55 (26.1)b1 | 29 (13.7)b2 | 33 (15.7) |
Benzothiazines | 28 (13.3) | 33 (15.6) | 24 (11.4) |
Aldosterone antagonists | 13 (6.2) | 13 (6.2) | 12 (5.7) |
Nitrates | 7 (3.3) | 13 (6.2) | 5 (2.4) |
Antiarrhythmic drugs | 7 (3.3) | 2 (0.9) | 2 (0.9) |
Glycosides | 10 (4.7) | 2 (0.9)a2 | 8 (3.8) |
ASS (100 mg to 300 mg) | 67 (31.8)b1 | 47 (22.3)a2 | 40 (19.0) |
Platelet aggregation inhibitors | 20 (9.5)b1 | 10 (4.7) | 6 (2.8) |
NSAIDs | 35 (16.6)b1 | 21 (10.0)a2 | 8 (3.8)a3 |
Metamizole | 21 (10.0) | 16 (7.6) | 21 (10.0) |
Potassium | 4 (1.9) | 3 (1.4) | 6 (2.8) |
Vitman K antagonists/coumarin derivates | 16 (7.6) | 9 (4.3) | 11 (5.2) |
Direct thrombin inhibitors | 6 (2.8) | 2 (0.9) | 4 (1.9) |
Glucocorticosteroids | 13 (6.2)b1 | 14 (6.6) | 41 (19.4)b3 |
Opioids | 20 (9.5) | 22 (10.4) | 23 (10.9) |
Metformin | 8 (3.8) | 16 (7.6) | 4 (1.9)b3 |
Insulin | 17 (8.1) | 15 (7.1) | 17 (8.1) |
Statins | 56 (26.5)a1 | 42 (19.9) | 38 (18.0) |
Fibrates | 7 (3.3)a1 | 1 (0.5)a2 | 1 (0.5) |
Levothyroxine | 25 (11.8) | 39 (18.5) | 22 (10.4)a3 |
Thyreostatics | 3 (1.4) | 3 (1.4) | 1 (0.5) |
Proton pump inhibitors | 100 (47.4) | 85 (40.3) | 81 (38.4) |
Penicillin derivates | 0 (0.0) | 2 (0.9) | 2 (0.9) |
Macrolides | 0 (0.0) | 1 (0.5) | 1 (0.5) |
Gyrase inhibitor | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Carbapenems | 1 (0.5) | 0 (0.0) | 0 (0.0) |
Imidazoles | 3 (1.4) | 1 (0.5) | 1 (0.5) |
Cephalosporins | 2 (0.9) | 2 (0.9) | 2 (0.9) |
Antbiotics | 4 (1.9) | 5 (2.4) | 3 (1.4) |
SSRIs | 14 (6.6) | 5 (2.4)a2 | 16 (7.6)a3 |
Tricyclic antidepressants | 7 (3.3) | 10 (4.7) | 7 (3.3) |
Neuroleptics | 5 (2.4) | 8 (3.8) | 6 (2.8) |
Sedatives | 16 (7.6) | 16 (7.6) | 16 (7.6) |
Others | 127 (60.2)a1 | 125 (59.2) | 147 (69.7)a3 |
Number of drugsb | 4.5 ± 2.8 | 3.9 ± 3.0a2 | 3.9 ± 3.2 |
Table 5 Echocardiographic parameters n (%)
Parameter | Drug-induced colitis, n = 54 of 211 (25.6) | Non-inflammatory controls, n = 34 of 211 (16.1) | Inflammatory controls, n = 24 of 211 (11.4) |
Dilated right atrium | 4 (7.4)a1 | 4 (11.4) | 5 (23.8) |
Dilated left ventricle | 8 (14.8) | 0 (0.0) | 6 (26.1)b3 |
Hypokinesia | 10 (18.5) | 5 (14.3) | 3 (13.0) |
Right heart failure | 5 (9.3) | 4 (11.4) | 2 (8.7) |
Diastolic dysfunction | 22 (43.1) | 16 (48.5) | 7 (30.4) |
LV Functionb2,b3 | |||
Normal (> 50%) | 39 (72.2) | 29 (85.3) | 17 (73.9) |
Slightly decreased (40%-50%) | 4 (7.4) | 5 (14.7) | 1 (4.3) |
Moderately decreased (30%-40%) | 5 (9.3) | 0 (0.0) | 2 (8.7) |
Severely decreased (< 30%) | 6 (11.1) | 0 (0.0) | 3 (13.0) |
Table 6 Binary logistic regression analysis
Parameter | Drug-induced colitis vs inflammatory controls OR (95%CI) | Drug-induced colitis vs non-inflammatory controls OR (95%CI) |
Heart failure | 0.6 (0.3-1.1) | 1.3 (0.6-2.8) |
Atherosclerosis | 2.1 (1.2-3.7)b | 1.7 (0.9-3.1) |
Dihydropyridines | 1.3 (0.7-2.5) | 1.0 (0.5-1.8) |
Diuretics | 1.5 (0.8-2.6) | 1.7 (1.0-3.0) |
Digitalis glycosides | 1.1 (0.4-3.1) | 3.7 (0.8-17.9) |
Low-dose ASS | 1.7 (1.0-2.8) | 1.1 (0.7-1.9) |
Platelet aggregation inhibitors | 2.0 (0.7-5.7) | 1.4 (0.6-3.3) |
NSAIDs | 6.7 (3.0-15.1)b | 2.2 (1.2-4.0)a |
Statins | 1.1 (0.6-1.9) | 0.9 (0.6-1.6) |
Fibrates | 9.1 (1.1-74.3)a | 8.9 (1.1-74.2)a |
- Citation: Brechmann T, Günther K, Neid M, Schmiegel W, Tannapfel A. Triggers of histologically suspected drug-induced colitis. World J Gastroenterol 2019; 25(8): 967-979
- URL: https://www.wjgnet.com/1007-9327/full/v25/i8/967.htm
- DOI: https://dx.doi.org/10.3748/wjg.v25.i8.967