Edoxaban-induced enterocolitis: The first case report demonstrating distinct endoscopic and histological features

Area of Science:

• Gastroenterology
• Pharmacology
• Internal Medicine

Background:

• Direct oral anticoagulants (DOACs) are commonly prescribed for stroke prevention in atrial fibrillation and venous thromboembolism.
• Gastrointestinal bleeding and diarrhea are known side effects of DOACs.
• DOAC-induced enterocolitis is not yet recognized as a distinct clinical entity.

Purpose of the Study:

• To report the first case of edoxaban-induced enterocolitis.
• To highlight the clinical, endoscopic, and histopathological features of this condition.
• To emphasize the need for increased clinical awareness and further research.

Main Methods:

• A case report of a 75-year-old woman presenting with bloody diarrhea after starting edoxaban.
• Diagnostic procedures included ileocolonoscopy and histopathological examination.
• Clinical course assessment after edoxaban discontinuation.

Main Results:

• The patient developed bloody diarrhea and anorexia five days after initiating edoxaban.
• Ileocolonoscopy revealed ileal ulcers and colonic edema with submucosal bleeding.
• Histopathology showed villous atrophy, lymphatic dilation, and mucosal inflammation, inconsistent with other causes.
• Symptoms resolved within three days of stopping edoxaban, with complete mucosal healing at three months.

Conclusions:

• The findings suggest edoxaban-induced enteritis as a potential adverse effect of DOACs.
• This case underscores the importance of considering drug-induced enterocolitis in patients on DOACs presenting with unexplained gastrointestinal symptoms.
• Further investigations are warranted to establish DOAC-induced enteritis as a distinct clinical entity.