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Miyaguchi K, Tsuzuki Y, Uemuara H, Ishizawa K, Shinomiya S, Matsumoto H, Shiomi R, Ohgo H, Nagata M, Nakamoto H, Imaeda H. Nintedanib-associated enterocolitis with intractable diarrhea: a case report. Clin J Gastroenterol 2024; 17:271-275. [PMID: 38042763 DOI: 10.1007/s12328-023-01894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 12/04/2023]
Abstract
Revised idiopathic pulmonary fibrosis treatment guidelines were published in 2015, and nintedanib was conditionally recommended. Although diarrhea is reported to be a common major adverse event associated with nintedanib, there have been few reports on detailed endoscopic findings of nintedanib-associated enterocolitis. A 74-year-old woman was diagnosed with idiopathic pulmonary fibrosis 4 years ago in May. She was started on nintedanib (300 mg). Three months later, hepatic dysfunction was observed; therefore, the drug was temporarily discontinued and then resumed at a dose reduction of 200 mg. Five months later, the patient developed diarrhea, and the dose was reduced to 150 mg. However, no effect was noted; hence, colonoscopy was performed. Various inflammatory lesions, such as erythema and erosions, were observed continuously at the rectum, which resembled ulcerative colitis. No improvement was observed 2 months after follow-up colonoscopy, and nintedanib-related enterocolitis was suspected. The dose was further reduced to 100 mg. Since the endoscopic findings of nintedanib-associated enterocolitis are similar to those of ulcerative colitis, it is critical to consider patients with diarrhea who are taking nintedanib as having associated enterocolitis and attempt to reduce or discontinue the drug if diarrhea does not improve with antidiarrheal agents.
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Affiliation(s)
- Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hayato Uemuara
- Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Keisuke Ishizawa
- Department of Pathology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Shun Shinomiya
- Department of Respiratory Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hisashi Matsumoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Rie Shiomi
- Department of General Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hideki Ohgo
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan
| | - Makoto Nagata
- Department of Respiratory Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, 350-0451, Japan
| | - Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, 350-0451, Japan.
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