Life-threatening diarrhea after short-term misoprostol use in a patient with Crohn ileocolitis
Article Abstract:
Nonsteroidal anti-inflammatory drugs can exacerbate ulcers; recently, misoprostol was approved for use in the prevention of ulcers produced by these drugs. Misoprostol, which is an analogue of prostaglandin E, often causes diarrhea and abdominal cramping, which may be related to the fact that prostaglandin E stimulates secretions in the small intestine and increases motility. A case is reported of a patient taking misoprostol who was stricken with diarrhea sufficiently severe to be life-threatening. The patient was taking naproxen, a nonsteroidal anti-inflammatory. Two days prior to admission she began taking misoprostol, since she had a history of previous bleeding ulcer. The woman began passing large quantities of watery diarrhea without blood. At the time of examination, her heart rate was 110, systolic blood pressure was 76 mm Hg, and mental status seemed dull. The patient was profoundly acidotic (ph 7.08) and required seven liters of saline before her blood pressure returned to 100 mm Hg. She continued to pass large volumes of watery stool despite no oral intake, and stool volume diminished over the next several days. On the ninth hospital day, colonoscopic examination revealed the cobblestone appearance associated with Crohn's disease, an inflammatory condition of the ileum. A review of the medical literature did not yield a description of any patient developing such severe diarrhea in response to misoprostol. While from 4 to 13 percent of patients develop diarrhea while taking the drug, only 4 out of 2,272 patients reported in one study required discontinuation of misoprostol due to diarrhea. A likely explanation for the severity of the present case is an interaction between the effects of the drug and the presence of Crohn's disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1990
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Intravenous iron and erythropoietin for anemia associated with Crohn disease: a randomized, controlled trial
Article Abstract:
Adding erythropoietin to intravenous iron therapy appears to improve hemoglobin count and quality of life among patients with Crohn's disease and anemia. Forty patients with anemia associated with Crohn's disease took either intravenous iron therapy alone or in combination with erythropoietin for eight weeks followed by eight weeks of combination therapy for all patients. Hemoglobin counts increased significantly for nearly all patients taking initial combination therapy and 75% of those taking iron alone. Erythropoietin added in the second eight weeks resulted in increased hemoglobin counts for the remaining patients.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1997
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Update in gastroenterology
Article Abstract:
Recent advances have been made in the study of stomach and intestinal disorders. Studies have found long-term success in treating severe heartburn with proton-pump inhibiting drugs. Ulcers caused by Helicobacter (H.) pylori infections appear to be readily identifiable with a simple breath test and effectively treated with a four-drug combination. A cause for many non-ulcer abdominal conditions still is elusive. Women who take aspirin routinely may lower their risk for colon cancer. Studies have also examined drugs to maintain remission of ulcerative colitis, treat pancreatitis, and prevent gallstones.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1997
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