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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
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Multi-Gene Single Nucleotide Polymorphism Detection in Gastric Cancer Based on Ion Semiconductor Sequencing Platform
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Methotrexate induced sprue-like syndrome.

Marta Maia Boscá1, Ramon Añón, Empar Mayordomo

  • 1Gastroenterology Department, Hospital Clinic Universitari of Valencia, Universitat de Valencia Avda. Blasco Ibanez 17 46010 Valencia, Spain. maiabosca@yahoo.es.

World Journal of Gastroenterology
|December 6, 2008
PubMed
Summary

Methotrexate treatment for ankylosing spondylitis can cause iron deficiency anemia due to duodenal villus atrophy. Stopping methotrexate and adopting a gluten-free diet resolved the anemia and duodenal changes.

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Published on: May 10, 2024

Area of Science:

  • Gastroenterology
  • Rheumatology
  • Hematology

Background:

  • Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine.
  • Methotrexate (MTX) is a common immunosuppressive drug used in AS treatment.
  • Iron deficiency anemia (IDA) can be a complication of gastrointestinal issues.

Observation:

  • A 52-year-old male with AS developed IDA after 10 months of MTX therapy.
  • The patient did not respond to oral iron or proton pump inhibitors.
  • Upper endoscopy revealed duodenal villus atrophy.

Findings:

  • Duodenal villus atrophy suggests MTX-induced enteropathy as the cause of IDA.
  • Discontinuation of MTX, intramuscular iron, and a gluten-free diet led to progressive resolution.
  • Histological and analytical markers of anemia and duodenal damage improved.

Implications:

  • Methotrexate-induced enteropathy should be considered in AS patients developing IDA.
  • Gluten-free diet may be beneficial in managing MTX-induced villus atrophy.
  • This case highlights the importance of monitoring for gastrointestinal side effects of MTX.