Phenotype of histologically suspected drug-induced colitis; results of a comparative, retrospective cohort study

Abstract

Background/aims: Drug-induced colitis (DiC) is a rarely reported form of colonopathy and data about the clinical and endoscopic characteristics are scarce. The aim was to investigate the phenotype of DiC.

Methods: Patients in a retrospective case control study were assigned to either DiC or one of two age- and gender-matched control groups (non-inflammatory controls and inflammatory colitis from other causes) based on histopathological findings. Patients’ basic characteristics, symptoms, biochemical results and endoscopic appearance were collected. Statistical analysis included ANOVA, the chi-squared test and two-tailed t-test.

Results: A total of 211 patients with DiC were included (97 males, age 62.1 ± 16.1 years, BMI 25.9 ± 6.1 kg m⁻²). In comparison to both control groups, DiC patients presented higher ASA and ECOG-scores and more particularly atherosclerotic comorbidities. The most abundant symptoms were abdominal pain (51.8%), diarrhoea (50.7%) and haematochezia (24.3%). The red blood cell count demarcated anaemia (12.7 ± 2.3 mg/dl) and C-reactive protein was slightly elevated (2.7 ± 5.2 mg/dl). The endoscopic features included erythema (46.9%), oedema (29.9%), erosions (29.9%) and ulcers (14.7%). The inflammation affected the rectum rarely (2.4%) but affected the rest of the colon without predilection in a segmental manner (p<.05). The severity of DiC was mostly mild (85.7%).

Conclusions: The phenotype of DiC differs slightly from that of colitis from other causes. Taking the clinical features into account might help to confirm drug-induced aetiology once the pathologist has raised the suspicion.

Keywords:

• Colonic toxicity
• drug-induced colitis
• drug-associated gastrointestinal disease
• colonoscopy

Acknowledgements

The manuscript has been proofread by a language editing service (Phillip Saunders, Language Support Services, Jablonskistr. 4a, D-10405 Berlin)

Patient consent

Written, informed consent was obtained from all patients before specific examinations.

Ethical approval

The study protocol and amendment have been reviewed and approved by the institutional review board of the Ruhr-University Bochum (registration number 16-5963) based on the ethical guidelines of the Declaration of Helsinki and its later revisions.

Disclosure statement

The authors declare that there is no actual or potential conflict of interest.