Analysis on lansoprazole-induced microscopic colitis in 62 patients

Abstract

Objective To analyze the clinical characteristics and risk factors of lansoprazole-induced microscopic colitis(MC). Methods PubMed, Da-Yi medical search, CHKD and Wanfang databases were searched and articles related to MC induced by lansoprazole were collected. The patients'primary diseases, coexisting diseases, the dosage, the way of administration, combination drugs, latent period, clinical manifestations, colonoscopic findings, the treatment measures, and the outcomes were recorded and the clinical characteristics, the risk factors of MC induced by lansoprazole were analyzed. Results A total of 30 articles and 62 patients with MCinduced by lansoprazole were retrieved. All articles were case reports and no randomized controlled trials were found. Of all the 62 patients, 22 were male (35.5%) and 40 were female (64.5%) with age from 36 to 92 years and the average age was (69±12) years; 57 patients (91.9%) were ＞50 years; 43 patients were with collagenous colitis(CC)(69.4%), 18 patients (29%) were with lymphocytic colitis(LC), and one patient with LC changed into CC(1.6%). All patients were treated with oral lansoprazole. The latent period of MCinduced by lansoprazole were 5d-6 years and within 1-6 months in 31 patients(60.8%). The most common clinical manifestations were non-bloody watery diarrhea (3-10 times daily in 59 patients,＞10 times daily in 3 patients). Intestinal mucosal screening was performed for all the patients and mild abnormalities or edema were observed in 37 patients, mucosal defect and mucosal laceration in 11 patients, epithelial collagen layer thickening, inflammatory cells infiltration in lamina propria,increased lymphocytes in intraepithelial spaces in 18 patients. High-risk drugs for drug-induced MC were combined use in 20 patients and the combination drugs in 13 patients were non steroidal antiinflammatory drugs. Fifty-eight patients with mild or moderate drug-induced MC returned to normal after withdrawl of lansoprazole and treatment with omeprazole or rabeprazole sodium and 4 patients with severe drug-induced MC recovered after withdrawl of lansoprazole and treatment with glucocorticoids. Conclusions The clinical characteristics in patients with MC induced by lansoprazole are watery diarrhea, mild abnormality or edema of colon mucosa, and thickening in the epithelium of colonic mucosa in histopathology. Age, gender, and combined use of drugs may be related to occurrence of MC induced by lansoprazole. Key words: Lansoprazole; Proton pump inhibitor; Colitis