Drug-induced digestive tract injury: decoding some invisible offenders

Area of Science:

• Gastroenterology
• Pathology
• Pharmacology

Background:

• Numerous pharmacological agents can cause significant gastrointestinal (GI) injury.
• Histopathologic diagnosis is often complicated by nonspecific symptoms and lack of drug history.
• Some drugs present characteristic features, while others show wide spectra and mimic other diseases.

Purpose of the Study:

• To review the histopathologic features of recently described drugs causing GI tract injury.
• To discuss common mimics and diagnostic pearls for distinguishing drug-induced injury.
• To emphasize the importance of recognizing drug-induced GI pathology for patient management.

Main Methods:

• Review of histopathologic findings associated with specific drugs.
• Analysis of differential diagnoses and mimics of drug-induced GI injury.
• Discussion of diagnostic challenges and pearls for pathologists.

Main Results:

• Detailed histopathologic features of doxycycline, tacrolimus, mycophenolate, immune checkpoint inhibitors, and olmesartan are discussed.
• Common histomorphologic mimics are identified.
• Strategies for differentiating drug-induced injury from other conditions are provided.

Conclusions:

• Awareness of the diverse histopathologic changes induced by drugs is crucial for accurate diagnosis.
• Distinguishing drug-induced GI injury from mimics prevents misdiagnosis and guides optimal patient management.
• Clinicopathologic correlation, including drug history, is essential for diagnosing drug-induced injury.