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Profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease
J S Johnson1, J A Karboski, G O Williams
1College of Pharmacy, University of Iowa, Iowa City 52242.
Objective:
To report a case of profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease and to discuss the role of eicosanoids in Crohn's disease.
Data Sources:
Patient medical records, case reports, review articles identified by MEDLINE, and personal communication with the physician, patient, and manufacturer.
Data Extraction:
From interviews, the manufacturer, and pertinent published sources by one author and reviewed by the others.
Data Synthesis:
A 55-year-old woman presented to clinic complaining of multiple joint pains. Her medical history was significant for peptic ulcer disease, hypertension, and Crohn's disease in remission since May 1989. Her joint pains were treated with ibuprofen 600 mg po qid and misoprostol 200 micrograms po qid (after meals and at bedtime). Following the administration of three doses of ibuprofen and misoprostol, the patient experienced abdominal cramps, pain, and voluminous, watery diarrhea for two days. Upon discontinuation of the ibuprofen and misoprostol, all of her gastrointestinal symptoms resolved within 12 hours. Rechallenge with ibuprofen alone failed to produce a recurrence of symptoms. Enhanced synthesis of intestinal eicosanoids has been demonstrated in Crohn's disease. Misoprostol, a synthetic analog of one of the eicosanoids, could induce a flare-up of Crohn's disease as suggested in this patient.
Conclusions:
Misoprostol should be used with caution in patients with known inflammatory bowel disease.
Insights
Misoprostol use in a patient with Crohn's disease led to severe diarrhea. This suggests misoprostol may exacerbate inflammatory bowel disease due to its eicosanoid properties.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Crohn's disease is a chronic inflammatory bowel disease.
- Eicosanoids play a role in intestinal inflammation.
- Misoprostol is a synthetic eicosanoid analog.
Observation:
- A patient with Crohn's disease experienced severe diarrhea after taking misoprostol for joint pain.
- Symptoms resolved upon discontinuation of misoprostol.
- Rechallenge with ibuprofen alone did not cause recurrence.
Findings:
- Enhanced synthesis of intestinal eicosanoids is observed in Crohn's disease.
- Misoprostol, as an eicosanoid analog, may trigger Crohn's disease flare-ups.
- The patient's symptoms suggest a link between misoprostol and Crohn's disease exacerbation.
Implications:
- Misoprostol should be used cautiously in patients with inflammatory bowel disease.
- Further research is needed to understand the interaction between misoprostol and Crohn's disease.
- This case highlights potential risks of eicosanoid analogs in IBD patients.