Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 18, 2023; 11(7): 351-367
Published online Dec 18, 2023. doi: 10.13105/wjma.v11.i7.351
Comprehensive analysis of sodium polystyrene sulfonate-induced colitis: A systematic review
Gabriel Peixoto Aver, Guilherme Ferreira Ribeiro, Vinícius Remus Ballotin, Francisco Souza dos Santos, Lucas Goldmann Bigarella, Floriano Riva, Eduardo Brambilla, Jonathan Soldera
Gabriel Peixoto Aver, Guilherme Ferreira Ribeiro, Vinícius Remus Ballotin, Francisco Souza dos Santos, Lucas Goldmann Bigarella, School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
Floriano Riva, Department of Pathology, CPM Laboratório de Patologia, Caxias do Sul 95084-900, RS, Brazil
Eduardo Brambilla, Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
Jonathan Soldera, Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: All authors contributed to study concept and design, and drafting of the manuscript; all authors contributed to acquisition of data, analysis, and interpretation of data; Ballotin VR contributed to statistical analysis; Brambilla E and Soldera J contributed to study supervision; all authors contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: All the authors have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Tutor, Acute Medicine and Gastroenterology, University of South Wales, University of South Wales, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: September 8, 2023
Peer-review started: September 10, 2023
First decision: September 29, 2023
Revised: October 4, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: December 18, 2023
Processing time: 97 Days and 5.2 Hours
Abstract
BACKGROUND

Sodium polystyrene sulfonate (SPS) is commonly prescribed for the management of hyperkalemia, a critical electrolyte imbalance contributing to over 800000 annual visits to emergency departments.

AIM

To conduct a systematic review of documented cases of SPS-induced colitis and assess its associated prognosis.

METHODS

Following the PRISMA-P guidelines, our study employed Medical Subject Headings and Health Sciences Descriptors, skillfully combined using Boolean operators, to conduct comprehensive searches across various electronic databases, including Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Language criteria were confined to English, Spanish, and Portuguese, with no limitations on the publication date. Additionally, we manually scrutinized the reference lists of retrieved studies. To present our findings, we utilized simple descriptive analysis.

RESULTS

Our search strategy yielded a total of 442 references. After rigorous evaluation, we included 51 references, encompassing 59 documented cases of colitis. Predominant clinical presentations included abdominal pain, observed in 35 (60.3%) cases, and bloating, reported in 18 (31%) cases. The most frequently affected sites of inflammation were the cecum, rectum, and small intestine, accounting for 31%, 25.8%, and 22.4% of cases, respectively. Colonoscopy findings were described in 28 (48.2%) cases, and 29 (50%) of patients required surgical intervention. Among the subset of patients for whom outcome data was available, 39 (67.2%) experienced favorable outcomes, while 12 (20.6%) unfortunately succumbed to the condition. The mean time required for resolution was 36.7 d, with a range spanning from 1 to 120 d.

CONCLUSION

SPS demonstrates the capacity to effectively lower serum potassium levels within 24 h. However, this benefit is not without the risk of bowel injury. Our study highlights the absence of high-quality data pertaining to the incidence of adverse events associated with SPS usage, making it challenging to determine whether the potential risks outweigh the benefits. However, a significant mortality rate related to SPS-induced colitis was noted. Future investigations should prioritize randomized controlled trials with a sufficiently large patient cohort to ascertain the true utility and safety profile of this medication.

Keywords: Sodium polystyrene sulfonate; Hyperkalemia; Colitis; Bowel necrosis; Kayexalate

Core Tip: Our systematic review on sodium polystyrene sulfonate (SPS)-induced colitis underscores the critical need for a comprehensive understanding of the associated risks. While SPS effectively addresses hyperkalemia, our findings reveal a notable incidence of bowel injury. With limited high-quality data available, the balance between benefits and risks remains unclear. Future research, particularly randomized controlled trials, is essential to determine the true utility and safety profile of SPS in clinical practice.