S2471 Life Savers or Colon Killers? A Peculiar Case of Excessive Sucralose Ingestion Preceding the Development of Inflammatory Bowel Disease

Abstract

Introduction: Inflammatory bowel disease (IBD) is characterized by chronic recurrent intestinal inflammation thought to result from host-microbial interactions and ill-defined environmental triggers in a genetically susceptible individual. We present a case of IBD temporally associated with the excessive ingestion of sucralose, the primary artificial sweetener in sugar free “Life Savers”. Case Description/Methods: A 65-year-old male was admitted with a one-week history of abdominal bloating, nausea, vomiting, and significant bloody diarrhea. He denied recent travel, sick contacts, dietary changes, NSAID or antibiotic use, but mentioned consuming approximately 50 “life savers” daily for the past month. On exam, vitals were normal and physical exam showed mild abdominal tenderness. Initial workup showed mild anemia, leukocytosis, acute kidney injury, elevated C-reactive protein, positive fecal leukocytes, and pancolitis on CT imaging. He was empirically started on ceftriaxone and metronidazole for possible infectious colitis, but he remained symptomatic. Evaluation showed no growth on stool culture, negative ova and parasites, and negative C. Diff. Colonoscopy was done which showed diffuse severe pan-colitis characterized by cobble-stoning and deep ulcerations most severe in ascending and descending colon. The sigmoid colon and rectum had milder involvement; terminal ileum was normal. Pathology showed markedly active chronic colitis with normal ileal mucosa and no sign of CMV. Intravenous methylprednisolone was initiated for suspected IBD. His diarrhea greatly improved. Patient was started on infliximab for likely Crohn’s colitis (given characteristic cobble-stoning), transitioned to oral steroids, and discharged home. At follow up, he remained clinically improved and steroid taper was initiated. Additional history revealed the patient had similar symptoms a year ago after a month of heavy Life Saver consumption. Discussion: This case adds to a growing body of literature temporally linking the consumption of sucralose with an increased incidence of IBD. It has been hypothesized these compounds inhibit gut flora through the inactivation of digestive proteases leading to accelerated degradation of the mucous layer and underlying endothelium. This exposes multiple immunogenic antigens and particles from the gut lumen which can cause dysregulated immune activation and development of IBD. Our case provides a dramatic example of such a toxicity given the excessive sucralose consumed and clear temporal association.Figure 1.: Patient colonoscopy showing active colitis.