Abstract
Drug-induced damage to the gastrointestinal mucosa has been mainly focused on damage in the upper tract. However, increasing evidence suggests that commonly used drugs may also affect the mucosa of the lower gut, and particularly in the colon. The aim of this study was to report that fairly homogeneous colonoscopic findings, correlate with histological evidence of drug-induced mucosal injury. Charts of patients with the “cherry tree” colonoscopic aspect were reviewed to correlate the endoscopic and histological findings for a possible association with the use of drugs. Data from 29 patients (5 men, 24 women, age range 16–76 years) with the “cherry tree” colonoscopic findings were analyzed. Histology revealed an increase in eosinophils in the left colon in 23 patients, pseudomelanosis coli in 3, and microscopic colitis in 3. The findings were associated with proton pump inhibitors in 19 (65.5 %), non-steroidal anti-inflammatory drugs or statins (3 cases each), and other drugs [4 cases, including estroprogestinics (1), antidepressants (2), and thyroxin (1)]. The “cherry tree” colonoscopic appearance suggests drug-induced colonic damage. Awareness of this association may prevent unnecessary, expensive and time-consuming procedures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pardi DS (2012) Miscellaneous colitides. Curr Opin Gastroenterol 28:76–81
Lee FD (1997) Drug-related intestinal disease. Curr Diagnost Pathol 4:128–134
Thiéfin G, Beaugerie L (2005) Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum. Joint Bone Spine 72:286–294
Pusztaszeri M, Girardin M, Hadengue A, Rubbia-Brandt L, Genevay M (2010) Drug-induced injury in the gastrointestinal tract: a clinico-pathological review. Rev Med Suisse 6:1650–1655
Casella G, Villanacci V, Fisogni S, Cambareri AR, Di Bella C, Corazzi N, Gorla S, Baldini V, Bassotti G (2009) Colonic left-side increase of eosinophils: a clue to drug-related colitis in adults. Aliment Pharmacol Ther 29:535–541
Villanacci V, Manenti S, Antonelli E, Chiudinelli M, Giuliano V, Bassotti G (2011) Non-IBD colitides: clinically useful histopathological clues. Rev Esp Enferm Dig 103:366–372
Parfitt JR, Driman DK (2007) Pathological effects of drugs on the gastrointestinal tract: a review. Hum Pathol 38:527–536
Hotouras A, Collins P, Speake W, Tierney G, Lund JN, Thaha MA (2012) Diagnostic yield and economic implications of endoscopic colonic biopsies in patients with chronic diarrhoea. Colorectal Dis 14:985–988
Villanacci V, Casella G, Bassotti G (2011) The spectrum of drug-related colitides: important entities, though frequently overlooked. Dig Liver Dis 43:523–528
Freeman HJ (2008) “Melanosis” in the small and large intestine. World J Gastroenterol 14:4296–4299
Chetty R, Govender D (2012) Lymphocytic and collagenous colitis: an overview of so-called microscopic colitis. Nat Rev Gastroenterol Hepatol 9:209–218
Rasmussen MA, Munck LK (2012) Systematic review: are lymphocytic colitis and collagenous colitis two subtypes of the same disease—microscopic colitis? Aliment Pharmacol Ther 36:79–90
Cappell MS (2004) Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol 99:1175–1190
Kusnik B, Stolte M (2010) Lymphocytic colitis under treatment with duloxetine. Z Gastroenterol 48:693–695
Fernández-Bañares F, Esteve M, Espinós JC, Rosinach M, Forné M, Salas A, Viver JM (2007) Drug consumption and the risk of microscopic colitis. Am J Gastroenterol 102:324–330
Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S (2008) Diagnosis and management of microscopic colitis. World J Gastroenterol 14:7280–7288
Okpara N, Aswad B, Baffy G (2009) Eosinophilic colitis. World J Gastroenterol 15:2975–2979
Villanacci V, Bassotti G, Cathomas G, Maurer CA, Di Fabio F, Fisogni S, Cadei M, Mazzocchi A, Salerni B (2006) Is pseudomelanosis coli a marker of colonic neuropathy in severely constipated patients? Histopathology 49:132–137
Pardi DS, Tremaine WJ, Rothenberg HJ, Batts KP (1998) Melanosis coli in inflammatory bowel disease. J Clin Gastroenterol 26:167–170
Byers RJ, Marsh P, Parkinson D, Haboubi NY (1997) Melanosis coli is associated with an increase in colonic epithelial apoptosis and not with laxative use. Histopathology 30:160–164
Liu J, Tian DA, Wang JP, Zhang SZ, Feng J, Zhao ZZ, Hao YX, Liu P (2011) Expression of aquaporin 8 and its relationship with melanosis coli. Chin Med J (Engl) 124:3061–3605
Procino G, Barbieri C, Carmosino M, Tamma G, Milano S, De Benedictis L, Mola MG, Lazo-Fernandez Y, Valenti G, Svelto M (2011) Fluvastatin modulates renal water reabsorption in vivo through increased AQP2 availability at the apical plasma membrane of collecting duct cells. Pflugers Arch 462:753–766
Kunkel J, Schmidt S, Loddenkemper C, Zeitz M, Schulzke JD (2009) Chronic diarrhea and melanosis coli caused by wellness drink. Int J Colorectal Dis 24:595–596
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dore, M.P., Villanacci, V., Manca, A. et al. Cherry-tree colon: colonoscopic appearance suggesting drug-induced mucosal injury. Intern Emerg Med 9, 405–409 (2014). https://doi.org/10.1007/s11739-013-0930-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11739-013-0930-1