| Theme |
Intestinal Mucosal Damage Induced by Drugs |
| Title |
Clinical Features of Drug-associated Colonic Lesions |
| Author |
Koichi Kurahara |
Division of Gastroenterology, Matsuyama Red-cross Hospital |
| Author |
Takayuki Matsumoto |
Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Mitsuo Iida |
Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University |
| [ Summary ] |
Antibiotic-associated colitis is classified into the categories of pseudomembranous colitis (PMC) and non-pseudomembranous colitis, including hemorrhagic colitis and methicillin-resistant Staphylococcus aureus(MRSA)colitis. PMC is most frequent in elderly and debilitated patients. Proliferation of Clostridium difficile and the subsequent release of clostridial cytotoxins causes pseudomembranous lesions. Antibiotic-associated hemorrhagic colitis is mainly caused by oral usage of Ampicillin and its derivatives in immunocompetents. Recently, cytotoxin-producing Klebsiella oxytoca has been suggested to be the causative organism in at least some cases of hemorrhagic colitis. MRSA related colitis, frequently seen in postoperative patients, has the characteristic clinical features of high fever, frequent vomiting and watery diarrhea. The mortality rate for this condition is very high without proper antibiotic therapy. NSAID-induced colopathy includes two distinctive entities： the colopathy with discrete ulcerations, and hemorrhagic or aphthoid colitis. While diaphragm-like strictures have been known to be the most characteristic phenotype of colonic involvement, ulceration should be regarded as a preceding stage of stricture formation. Further epidemiological studies and therapeutic trials are warranted to clarify NSAID-induced colopathy. |