Gastric changes following colchicine therapy in patients with FMF
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Wael Ismail Al-Daraji1, Riham M W Al-Mahmoud, Mohammed Ilyas
1Department of Pathology, School of Molecular Medicine, University of Nottingham, Nottingham, UK. waldaraji@aol.com
Background:
Familial Mediterranean fever (FMF) is also called recurrent polyserositis. The salient features of this disease include brief recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. Colchicine is highly effective in the treatment of FMF and in preventing the development of recurrent attacks and amyloidosis, and it is essential to make the correct diagnosis and institute daily therapy with colchicine (0.5-0.6 mg bid). Colchicine is used to treat a variety of conditions but it is known to have gastrointestinal (GI) side effects. In this study, effects of colchicines on the gastrointestinal tract were evaluated in patients with FMF treated with colchicine.
Methods:
Biopsies were reviewed from 43 patients attending Ain Shams University Hospital (Egypt) who were diagnosed with FMF and treated with colchicine. One-hundred and twelve GI biopsies, obtained over a 14-year period, were reviewed. This included biopsies from stomach body (38), stomach antrum (50), and colon (24). In addition, gastric biopsies were reviewed from 17 control patients who did not have FMF and were not on colchicine.
Results:
Three patients known to have FMF and on colchicine therapy showed typical histological features of colchicine (metaphase mitoses, epithelial pseudoproliferation, mucin depletion, and frequent apoptosis). These features were seen only in gastric antral biopsies and not in colonic biopsies. None of the control group showed the characteristic morphological features of colchicine toxicity.
Conclusion:
This is the first report of histological changes seen in the stomach following colchicine therapy. In contrast with previous reports, we did not find any definitive change in the large intestine. Our data show that gastric changes can be encountered in symptomatic patients who have recently had colchicine. If these finding are seen histologically, they merit correlation with the clinical impression and should not be interpreted as toxicity in isolation.
Insights
Colchicine treatment for Familial Mediterranean Fever (FMF) can cause specific histological changes in the stomach lining, particularly the antrum. These gastric changes, including apoptosis and pseudoproliferation, were not observed in the colon or in patients not taking colchicine.
Area of Science:
- Gastroenterology
- Rheumatology
- Histopathology
Background:
- Familial Mediterranean Fever (FMF), or recurrent polyserositis, presents with recurrent episodes of serositis and fever.
- Colchicine is the gold standard treatment for FMF, effectively preventing attacks and amyloidosis.
- Gastrointestinal (GI) side effects are known complications of colchicine therapy.
Purpose of the Study:
- To evaluate the histological effects of long-term colchicine treatment on the gastrointestinal tract in FMF patients.
- To identify specific morphological changes associated with colchicine use in GI biopsies.
Main Methods:
- Review of 112 GI biopsies (stomach body, antrum, colon) from 43 FMF patients on colchicine.
- Comparison with gastric biopsies from 17 control patients not on colchicine.
- Histological analysis for colchicine-induced changes like apoptosis, pseudoproliferation, and mucin depletion.
Main Results:
- Three FMF patients on colchicine exhibited characteristic histological features of colchicine toxicity in gastric antral biopsies.
- These specific changes included metaphase mitoses, epithelial pseudoproliferation, mucin depletion, and frequent apoptosis.
- No definitive colchicine-related histological changes were observed in colonic biopsies or in the control group.
Conclusions:
- This study reports novel histological changes in the stomach associated with colchicine therapy in FMF patients.
- Gastric antral changes, but not colonic changes, were identified as potential indicators of colchicine effects.
- Histological findings should be correlated with clinical presentation and not solely interpreted as toxicity.
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