Drug-induced gastrointestinal disease

Charcoal bezoar. Small-bowel obstruction secondary to amitriptyline overdose therapy

Nasogastric administration of activated charcoal is effective in decreasing the half-life of amitriptyline. A case is reported in which this therapy for amitriptyline overdose led to charcoal bezoar formation and small-bowel obstruction. Amitriptyline's atropinic side effects on the gut make this a possible complication in such patients.

Double-contrast enema in antibiotic-related pseudomembranous colitis

Pseudomembranous colitis (PMC) is a potentially fatal disease often associated with antibiotic therapy. The condition is now known to be due to an enterotoxin produced by Clostridium difficile. Diagnosis is based on the endoscopic finding of the typical pseudomembranes, stool culture, and assay of the stools for the specific toxin. Radiography with double-contrast medium (DCE), which can be performed in patients not critically ill, often yields pathognomonic findings and permits early diagnosis.

The double-contrast barium meal: a correlation with endoscopy

The radiological and endoscopic findings are described in 214 patients with 252 lesions in whom endoscopy had been requested by a radiologist either to confirm or clarify a radiological opinion. There was radiological and endoscopic agreement about the presence or absence of oesophagitis in 73% of patients, but there was agreement about the presence or absence of duodenitis in only 48%. There were only two cases of early gastric cancer, and no early gastric cancers were found in a group of 43 patients on whom endoscopy had been specifically requested because of an abnormal gastric mucosal pattern. Endoscopy failed to detect 13% of gastric ulcers at the initial endoscopic examination.

Medication bezoar: intestinal obstruction by an isocal bezoar. Case report and review of the literature

Medications may occasionally obstruct the gastrointestinal tract by virtue of their physical mass. Obturative obstruction of the alimentary tract is reportedly caused by an increasing number of medications, including hydroscopic bulk laxatives, cholestyramine, nonabsorbable antacids, and vitamin C tablets. Inspissated Isocal tube feedings caused jejunal obstruction in a postoperative patient. Medication bezoars are a rare cause of intestinal obstruction that may result in significant patient morbidity, including bowel necrosis, perforation, and peritonitis. The radiographic appearance may mimic an abdominal abscess.

Myxedema megacolon

The radiological findings on barium enema examination of 239 patients with thyroid deficiency (192 hypothyroid and 47 myxedematous) were reviewed. A new radiologic finding of transverse ridging superimposed on megacolon is described in myxedema and an explanation for this finding is postulated. The colonic findings associated with thyroid deficiency are presented.

Acute colitis related to penicillin and penicillin derivatives

5 cases of acute transient colitis associated with the ingestion of ampicillin, an ampicillin derivative, and penicillin are discussed. The clinical presentation, course, and radiographic and sigmoidoscopic findings are distinct from those in pseudomembranous colitis. The colonic changes may be related to an allergic reaction in the intestine which results primarily in transient ischaemia. The presenting symptom is blood diarrhoea, and barium enema is the most productive diagnostic examination.