Portal de Periódicos da CAPES

Ulcerations of the colon associated with naproxen and acetylsalicylic acid treatment

1986; Elsevier BV; Volume: 32; Issue: 3 Linguagem: Inglês

10.1016/s0016-5107(86)71824-5

1097-6779

A. Uribe, C. Johansson, Peter Slezák, Carlos Rubio-Terrés,

Gastroesophageal reflux and treatments

Pills in the colonTo the Editor:Finding intact pills in the colonic lumen is unusual.Foutch and Fleischer!reported finding procainamide pills in the descending colon during colonoscopy and suggested that "pill malabsorption" may have resulted from the use of an oral lavage solution for colonoscopic preparation.We report two patients who were taking a long-acting procainamide formulation and who had intact pills in the colon seen at colonoscopy.A review of the literature and measurements of serum drug levels indicate that this is an expected finding with the medication in question.The first case involves a 70-year-old man who was admitted with increasing angina, fatigue, anorexia, and a 15-pound weight loss.His medications on admission were propranolol, nitroglycerin, and multivitamins.Examination revealed mild congestive heart failure, but was otherwise unremarkable.His stool was negative for occult blood.Laboratory evaluation suggested iron deficiency anemia with a hemoglobin of 6.7 gldl.Acute myocardial infarction was ruled out, but on the third hospital day the patient experienced episodes of ventricular tachycardia.He was treated with procainamide hydrochloride (Procan@ SR), 1500 mg every 6 hours.Subsequent serum levels of procainamide were in the therapeutic range for our laboratory.To evaluate the patient's iron deficiency anemia, colonoscopy was performed.After standard preparation, including 3 days of clear liquids, oral cathartics, and enemas, colonoscopy to the cecum was performed.No pathologic lesions were seen; however, three intact pills were seen in the cecum.Serum procainamide levels, before and several days after the procedure, remained in the therapeutic range; during this period the procainamide dose was not changed.Subsequent evaluation revealed a well differentiated adenocarcinoma involving the esophagogastric junction.The second case involves a 73-year-old man who was admitted with complaints of cough, fever, and chills.His past history was remarkable for celiac sprue, diagnosed by small intestinal biopsy in 1967, and subsequently well controlled by dietary restriction of gluten.However, in the last 2 months he had noted an increase in stool frequency to six to eight stools per day.His only medication on admission was propranolol.Physical examination was compatible with a left lower lobe pneumonia.The patient had occult blood in his stool, and laboratory values suggested iron deficiency anemia.Three days after admission he developed atrial fibrillation with a ventricular rate of 90 to 100.Procainamide hydrochloride (Procan@ SR), 500 mg every 6 hours, was started and resulted in restoration of sinus rhythm.Serum procainamide level was 3.9 (therapeutic range, 4 to 8 mgl dI).Although the patient's increased stool frequency was felt to be a result of dietary indiscretion (gluten), colonoscopy was performed to rule out other causes for his iron deficiency anemia.Preparation for colonoscopy was the same as for the patient described in the first case.No colonic lesions were demonstrated; however, an intact Procan@ SR tablet was present in the transverse colon.Subsequent small bowel biopsy showed villous atrophy, consistent with an exacerbation of his sprue.