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. 1995 Nov;37(5):708–711. doi: 10.1136/gut.37.5.708

Ranitidine, diarrhoea, and lymphocytic colitis.

L Beaugerie 1, N Patey 1, N Brousse 1
PMCID: PMC1382879  PMID: 8549950

Abstract

A 69 year old woman developed chronic diarrhoea while being treated with ranitidine. Sigmoidoscopy was performed after six weeks and showed typical histological features of lymphocytic colitis. Ranitidine was withdrawn and the diarrhoea resolved. Eight months later, a 72 hour oral rechallenge period of ranitidine, was performed immediately preceded (period 1) and followed (period 2) by sigmoidoscopy and biopsy. Diarrhoea recurred during the rechallenge period and resolved again within one day after drug withdrawal. The mean (SEM) intraepithelial lymphocyte count was not significantly different between periods 1 and 2 (11.9 (0.6) and 13.1 (0.4) per 100, respectively). An immunopathological study of 30 serial sections of biopsy specimens was performed for both periods 1 and 2. The expression of HLA-DR by the rectal epithelium was mild or absent in all sections from period 1, and was considerable in 25 of 30 sections from period 2 (p < 10(-9)). It is suggested that the oral intake of ranitidine was responsible for the diarrhoea and induced the immunopathological signs of activation of the rectal mucosal immune system during the rechallenge period.

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Selected References

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  1. Beaugerie L., Luboinski J., Brousse N., Cosnes J., Chatelet F. P., Gendre J. P., Le Quintrec Y. Drug induced lymphocytic colitis. Gut. 1994 Mar;35(3):426–428. doi: 10.1136/gut.35.3.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bo-Linn G. W., Vendrell D. D., Lee E., Fordtran J. S. An evaluation of the significance of microscopic colitis in patients with chronic diarrhea. J Clin Invest. 1985 May;75(5):1559–1569. doi: 10.1172/JCI111861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bogomoletz W. V., Flejou J. F. Microscopic colitis: a "transatlantic" unifying concept. Gastroenterology. 1994 Jun;106(6):1727–1727. doi: 10.1016/0016-5085(94)90449-9. [DOI] [PubMed] [Google Scholar]
  4. Choy M. Y., Walker-Smith J. A., Williams C. B., MacDonald T. T. Differential expression of CD25 (interleukin-2 receptor) on lamina propria T cells and macrophages in the intestinal lesions in Crohn's disease and ulcerative colitis. Gut. 1990 Dec;31(12):1365–1370. doi: 10.1136/gut.31.12.1365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Giardiello F. M., Hansen F. C., 3rd, Lazenby A. J., Hellman D. B., Milligan F. D., Bayless T. M., Yardley J. H. Collagenous colitis in setting of nonsteroidal antiinflammatory drugs and antibiotics. Dig Dis Sci. 1990 Feb;35(2):257–260. doi: 10.1007/BF01536772. [DOI] [PubMed] [Google Scholar]
  6. Giardiello F. M., Lazenby A. J., Bayless T. M., Levine E. J., Bias W. B., Ladenson P. W., Hutcheon D. F., Derevjanik N. L., Yardley J. H. Lymphocytic (microscopic) colitis. Clinicopathologic study of 18 patients and comparison to collagenous colitis. Dig Dis Sci. 1989 Nov;34(11):1730–1738. doi: 10.1007/BF01540051. [DOI] [PubMed] [Google Scholar]
  7. Hirata I., Austin L. L., Blackwell W. H., Weber J. R., Dobbins W. O., 3rd Immunoelectron microscopic localization of HLA-DR antigen in control small intestine and colon and in inflammatory bowel disease. Dig Dis Sci. 1986 Dec;31(12):1317–1330. doi: 10.1007/BF01299810. [DOI] [PubMed] [Google Scholar]
  8. Kingham J. G., Levison D. A., Ball J. A., Dawson A. M. Microscopic colitis-a cause of chronic watery diarrhoea. Br Med J (Clin Res Ed) 1982 Dec 4;285(6355):1601–1604. doi: 10.1136/bmj.285.6355.1601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lazenby A. J., Yardley J. H., Giardiello F. M., Jessurun J., Bayless T. M. Lymphocytic ("microscopic") colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol. 1989 Jan;20(1):18–28. doi: 10.1016/0046-8177(89)90198-6. [DOI] [PubMed] [Google Scholar]
  10. Leocata V., Incalcaterra C., Angelico M. Nodular transformation of the liver: a reply. Gastroenterology. 1993 Nov;105(5):1593–1594. doi: 10.1016/0016-5085(93)90192-f. [DOI] [PubMed] [Google Scholar]
  11. MacDonald T. T., Weinel A., Spencer J. HLA-DR expression in human fetal intestinal epithelium. Gut. 1988 Oct;29(10):1342–1348. doi: 10.1136/gut.29.10.1342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mayer L., Eisenhardt D., Salomon P., Bauer W., Plous R., Piccinini L. Expression of class II molecules on intestinal epithelial cells in humans. Differences between normal and inflammatory bowel disease. Gastroenterology. 1991 Jan;100(1):3–12. doi: 10.1016/0016-5085(91)90575-6. [DOI] [PubMed] [Google Scholar]
  13. Read N. W., Krejs G. J., Read M. G., Santa Ana C. A., Morawski S. G., Fordtran J. S. Chronic diarrhea of unknown origin. Gastroenterology. 1980 Feb;78(2):264–271. [PubMed] [Google Scholar]
  14. Riddell R. H., Tanaka M., Mazzoleni G. Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis: a case-control study. Gut. 1992 May;33(5):683–686. doi: 10.1136/gut.33.5.683. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Wang K. K., Perrault J., Carpenter H. A., Schroeder K. W., Tremaine W. J. Collagenous colitis: a clinicopathologic correlation. Mayo Clin Proc. 1987 Aug;62(8):665–671. doi: 10.1016/s0025-6196(12)65216-1. [DOI] [PubMed] [Google Scholar]
  16. Wormsley K. G. Safety profile of ranitidine. A review. Drugs. 1993 Dec;46(6):976–985. doi: 10.2165/00003495-199346060-00004. [DOI] [PubMed] [Google Scholar]

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