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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2017; 9(8): 405-410
Published online Aug 16, 2017. doi: 10.4253/wjge.v9.i8.405
Correlation of abnormal histology with endoscopic findings among mycophenolate mofetil treated patients
Mitchell A Izower, Merajur Rahman, Ernesto P Molmenti, Madhu C Bhaskaran, Viren G Amin, Sundas Khan, Keith Sultan
Mitchell A Izower, Viren G Amin, Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, United States
Merajur Rahman, Keith Sultan, Division of Gastroenterology, Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, United States
Ernesto P Molmenti, Department of Surgery, North Shore University Hospital, Manhasset, NY 11030, United States
Madhu C Bhaskaran, Divison of Nephrology, Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, United States
Sundas Khan, the Feinstein Institute for Biomedical Research, Manhasset, NY 11030, United States
Author contributions: Izower MA, Rahman M, Molmenti EP, Bhaskaran MC, Amin VG and Sultan K involvement in conception or design, contributions to critical aspects of the research, drafting and revising the article; Khan S data analysis of the research.
Institutional review board statement: The study was reviewed and approved by the North Shore-Long Island Jewish Institutional Review Board.
Informed consent statement: Waiver of informed consent was requested and granted by the North Shore-Long Island Jewish Institutional Review board because information recorded by the investigators in such a manner that the subjects cannot be identified, directly or through identifiers linked to the subjects.
Conflict-of-interest statement: All authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Merajur Rahman, MD, Division of Gastroenterology, Department of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, United States. rmerajur@nshs.edu
Telephone: +1-516-3873990 Fax: +1-516-5623555
Received: January 22, 2017
Peer-review started: January 22, 2017
First decision: March 28, 2017
Revised: April 23, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: August 16, 2017
Processing time: 201 Days and 5 Hours
AIM
To describe all abnormal histological findings and their associated endoscopic presentation in patients using mycophenolate mofetil (MMF).
METHODS
A retrospective review of all individuals prescribed MMF within 6 mo of a colonoscopy or flexible sigmoidoscopy between 07/2009 and 09/2015 was performed within Northwell Health system. Records were analyzed for age, gender, procedure indication, MMF indication, and both gross and microscopic findings. Only reports with abnormal histology were included.
RESULTS
One hundred and eighty-four procedures from 170 patients were found, of which 39 met inclusion criteria. Fifty-one point three percent were female. MMF was used for solid organ transplant in 71.8%. Diarrhea was the indication for 71.8% of colonoscopies. Fifty-nine percent of reports revealed gross and microscopic abnormalities while 41.0% had only microscopic findings. Only 11 patients’ reports (28.2%) indicated a specific histopathology of MMF colitis. Among the entire group, only 23.1% of abnormal histology was isolated proximal to the splenic flexure.
CONCLUSION
Our results demonstrate a high rate of left sided disease and microscopic findings without gross mucosal abnormalities among patients using MMF. Also, a broader definition of MMF-colonopathy may be appropriate, with a majority of our abnormal histology falling outside of the more narrowly defined MMF-colitis category. Given the high frequency of isolated microscopic abnormalities and distal disease, sigmoidoscopy with random biopsies may be an appropriate, less invasive initial endoscopic examination in selected MMF patients.
Core tip: Gastrointestinal complaints are common among patients using mycophenolate mofetil (MMF). Little information exits to guide an effective endoscopic workup in this population. A retrospective review of all patients prescribed mycophenolate within 6 mo of an endoscopic procedure was performed. Our results demonstrate a high rate of left sided disease and microscopic findings without gross mucosal abnormalities among patients using mycophenolate. A broader definition of MMF-colonopathy may be appropriate, with a majority of our abnormal histology falling outside of the more narrowly defined MMF-colitis category. Our findings suggest sigmoidoscopy with random biopsies may be an appropriate initial evaluation.
