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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
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Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
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Kayexalate-induced colitis and rectal stricture.

Padmini Krishnamurthy1,2, Sangeeta Agrawal2

  • 1Department of Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, USA padmini.krishnamurthy@va.gov.

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Misdiagnosis of Crohn's colitis occurred due to overlooked Kayexalate crystals in rectal biopsies. Prompt identification of this medication-induced injury led to treatment cessation and colitis resolution, highlighting diagnostic challenges in gastrointestinal pathology.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Gastrointestinal Pathology

Background:

  • A 57-year-old male presented with acute recto-sigmoid obstruction.
  • Initial hospitalization was for diabetic ketoacidosis (DKA) and hyperkalemia, with no prior gastrointestinal complaints.

Observation:

  • Surgical exploration and sigmoidoscopy revealed sigmoid colon and rectal ulcerations with a mid-rectum stricture.
  • Initial biopsies were interpreted as Crohn's colitis, leading to treatment with infliximab and 6-mercaptopurine (6-MP).

Findings:

  • Re-evaluation of biopsies identified crystals suggestive of Kayexalate, a medication administered rectally for DKA treatment.
  • Discontinuation of infliximab and 6-MP resulted in complete resolution of colitis, while the rectal stricture persisted.

Implications:

  • This case underscores the importance of thorough histopathological review and clinical correlation to avoid misdiagnosis of inflammatory bowel disease.
  • Medication-induced injury, specifically from Kayexalate, can mimic Crohn's colitis, necessitating careful consideration of patient history and iatrogenic causes.