Upper gastrointestinal tract injury in patients receiving kayexalate (sodium polystyrene sulfonate) in sorbitol - Clinical, endoscopic, and histopathologic findings
Upper gastrointestinal tract injury in patients receiving kayexalate (sodium polystyrene sulfonate) in sorbitol - Clinical, endoscopic, and histopathologic findings
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DOI：
10.1097/00000478-200105000-00011
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发表时间：
2001-05-01
影响因子：
5.6
通讯作者：
Wu, TT
中科院分区：
文献类型：
--
作者：
Abraham, SC;Bhagavan, BS;Wu, TT
山梨醇中的Kayexalate（聚苯乙烯磺酸钠）已被证明可引起部分尿毒症患者的结肠坏死，这些患者使用阳离子交换树脂治疗高钾血症。与山梨糖醇中的Kayexalate相关的上消化道损伤报道的频率要低得多，而且上消化道损伤病例的临床病理谱以前也没有研究过。作者研究了11例食道（n = 7）、胃（n = 6）和十二指肠（n = 2）活检中Kayexalate晶体的临床、内镜和组织学特征。所有11例患者的内窥镜表现均明显异常。在食管癌、念珠菌性食管炎3例中，该药的效果与其他内镜和放射学诊断非常相似。还有胃牛黄。9例（82%）患者存在溃疡或糜烂形式的黏膜损伤的组织学和/或内镜证据。在4例粘膜损伤患者中，除了山梨醇中的Kayexalate外，没有其他病因可以确定。与同一时期在下消化道标本中发现Kayexalate晶体的患者队列（11例患者）相比，相关粘膜损伤的频率无显著差异（55%,p = 0.19），但没有上消化道Kayexalate患者需要手术切除或因Kayexalate诱导的粘膜损伤而死亡。本研究结果证明山梨糖醇中的Kayexalate可引起上消化道损伤。在组织学切片中识别Kayexalate晶体作为山梨糖醇诱导的粘膜损伤的标记物可能有助于对临床或内镜下误导性病变建立正确的诊断。
Kayexalate (sodium polystyrene sulfonate) in sorbitol has been demonstrated to cause colonic necrosis in a subset of uremic patients who are administered the cation exchange resin for treatment of hyperkalemia. Upper gastrointestinal damage associated with Kayexalate in sorbitol is reported far less frequently, and the clinicopathologic spectrum of disease in cases with upper gastrointestinal damage has not been investigated previously. The authors studied the clinical, endoscopic, and histologic features of 11 patients with Kayexalate crystals in biopsies from the esophagus (n = 7), stomach (n = 6), and duodenum(n = 2). The endoscopic appearance was markedly abnormal in all 11 patients. The effects of the medication closely mimicked other endoscopic and radiologic diagnoses in three cases, including esophageal carcinoma, Candidal esophagitis. and gastric bezoar. Histologic and/or endoscopic evidence of mucosal injury in the form of an ulcer or erosion was present in nine patients (82%). In four patients with mucosal injury, no other etiology apart from Kayexalate in sorbitol could be identified. In comparison with a cohort of patients with Kayexalate crystals in lower gastrointestinal specimens identified during the same period (11 patients) the frequency of associated mucosal damage was not significantly different (55%, p = 0.19), but no patient with upper gastrointestinal Kayexalate required surgical resection or died as a result of Kayexalate-induced mucosal injury. The results of this study provide evidence that Kayexalate in sorbitol can induce damage to the upper gastrointestinal tract. Recognition of Kayexalate crystals in histologic sections as a marker for sorbitol-induced mucosal damage may aid in establishing the correct diagnosis for clinically or endoscopically misleading lesions.