|
[PMID]: | 24921636 |
[Au] Autor: | Arnold MA; Swanson BJ; Crowder CD; Frankel WL; Lam-Himlin D; Singhi AD; Stanich PP; Arnold CA |
[Ad] Endereço: | *Department of Pathology ¶Department of Internal Medicine, Ohio State University Wexner Medical Center †Department of Pathology, Nationwide Children's Hospital, Columbus, OH ‡Department of Pathology, Mercy Medical Center, Des Moines, IA §Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ ∥Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA. |
[Ti] Título: | Colesevelam and colestipol: novel medication resins in the gastrointestinal tract. |
[So] Source: | Am J Surg Pathol;38(11):1530-7, 2014 Nov. | [Is] ISSN: | 1532-0979 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | We report the morphologic description of the bile acid sequestrants (BAS) colesevelam and colestipol, as well as the largest series of cholestyramine. Histologically similar medication resins from 4 institutions were prospectively collected over 1 year (26 specimens, 15 patients). Comorbidities included hyperlipidemia (4/15), hypertension (4/15), inflammatory bowel disease (4/15), coronary artery disease (3/15), diarrhea (7/15), hypothyroidism (2/15), and ischemic bowel (1/15). Sites of involvement included the esophagus (1/26), stomach (1/26), small intestine (1/26), ileocecal valve (1/26), and colorectum (22/26). Associated histologic diagnoses included normal (8/26), chronic mucosal injury (11/26), acute inflammation (9/26), erosion/ulceration (6/26), and cytomegalovirus (2/26). The BAS resins were histologically indistinguishable from each other; they were all eosinophilic on hematoxylin and eosin (H&E) and lacked internal "fish-scales." To validate these observations, respective medications were submitted for histologic processing; the processed medications were identical to those in the patient specimens. Rare, irregular "fracture" lines presented diagnostic pitfalls by mimicking the true "fish-scales" of Kayexalate and sevelamer. Clues to the correct identification of BAS include recognition that the "fracture" lines were subtle, irregular, and restricted to large fragments or thick sections, likely representing a processing artifact. Moreover, Kayexalate is violet on H&E and black on acid fast bacillus, and sevelamer characteristically displays a 2-tone color on H&E and is magenta on acid fast bacillus. An association with inflammatory injury was seen (15/26). We believe that the BAS are innocent bystanders in complicated patients, although we cannot exclude their ability to cause mucosal injury in specific settings. |
[Mh] Termos MeSH primário: |
Alilamina/análogos & derivados Anticolesterolemiantes/análise Colestipol/análise Fármacos Gastrointestinais/análise Intestinos/química Resinas de Troca Iônica/análise
|
[Mh] Termos MeSH secundário: |
Adulto Idoso Alilamina/efeitos adversos Alilamina/análise Anticolesterolemiantes/efeitos adversos Biópsia Resina de Colestiramina/análise Cloridrato de Colesevelam Colestipol/efeitos adversos Feminino Fármacos Gastrointestinais/efeitos adversos Seres Humanos Mucosa Intestinal/química Mucosa Intestinal/efeitos dos fármacos Intestinos/efeitos dos fármacos Resinas de Troca Iônica/efeitos adversos Masculino Meia-Idade Estudos Prospectivos Medição de Risco Fatores de Risco Estados Unidos
|
[Pt] Tipo de publicação: | JOURNAL ARTICLE; MULTICENTER STUDY |
[Nm] Nome de substância:
| 0 (Anticholesteremic Agents); 0 (Gastrointestinal Agents); 0 (Ion Exchange Resins); 11041-12-6 (Cholestyramine Resin); 48G762T011 (Allylamine); K50N755924 (Colestipol); P4SG24WI5Q (Colesevelam Hydrochloride) |
[Em] Mês de entrada: | 1412 |
[Cu] Atualização por classe: | 151119 |
[Lr] Data última revisão:
| 151119 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 140613 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1097/PAS.0000000000000260 |
|
|
|