P0210 - Acute Ischemic Colitis Secondary to Oral Phenylephrine: An Unusual Adverse Effect of a Common Drug

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

MG

Muhammad Hassan Naeem Goraya, MBBS

Services Institute of Medical Sciences
Lahore, Punjab, Pakistan

Muhammad Hassan Naeem Goraya, MBBS¹, Junaid Rasul Awan, MBBS², Hafiz M. Kashif Saleem, MD³, Faisal Inayat, MBBS³, Zahid I. Tarar, MD⁴, Zahra Akhtar, MBBS⁵, Gul Nawaz, MD⁶, Nadeem Hussain, MD³, Adnan Malik, MD⁷, Muhammad Adnan Zaman, MD⁸
¹Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ²University Hospital Limerick, Limerick, Limerick, Ireland; ³Allama Iqbal Medical College, Lahore, Punjab, Pakistan; ⁴University of Missouri School of Medicine, Columbia, MO; ⁵University of Texas Medical Branch, Galveston, Galveston, TX; ⁶Marshfield Clinic, Marshfield, WI; ⁷Loyola University Medical Center, Maywood, IL; ⁸Wexham Park Hospital, Slough, England, United Kingdom

Introduction: Ischemic colitis (IC) is a well-defined disease process caused by a myriad of etiologies. It is usually diagnosed by colonoscopy and biopsy. We hereby delineate only the third case of acute IC following the use of oral phenylephrine. We also review the literature on colonic ischemia related to the use of oral phenylephrine.

Case Description/Methods: A 23-year-old Caucasian female presented to the emergency department with a 2-day history of moderate, colicky, left lower quadrant (LLQ) abdominal pain. It was initially associated with watery diarrhea, which progressed to overt hematochezia. She had severe nasal congestion and a common cold, and extensively used OTC phenylephrine (DayQuil LiquiCaps). She developed GI symptoms after 2 days of phenylephrine usage. She denied smoking, alcoholism, and illicit drugs. On admission, her vital signs were normal. Abdominal examination revealed LLQ tenderness. Laboratory studies revealed a white cell count of 14.3 x 10⁹/L and hemoglobin of 13.5 g/dL. Her cell counts, metabolic profile, and organ function tests were normal. Blood and stool cultures ruled out infection. Coronavirus testing was negative. Tests for IBD and Clostridium difficile were negative. CT abdomen showed abnormal wall thickening of the descending colon. Colonoscopy revealed diffuse circumferential ulcerated, erythematous, edematous, and friable mucosa in the descending colon and biopsy confirmed the diagnosis of IC. After 2 days of conservative treatment, she showed a clear improvement in her symptoms. Based on workup findings and exclusion of plausible etiologies, oral phenylephrine-induced IC was considered (Naranjo score: 8). She was discharged home in a stable condition. No GI symptoms were reported on follow-up.

Discussion: Phenylephrine has rarely been implicated in causing IC. A MEDLINE search was conducted for all case reports of IC following phenylephrine use published between inception and June 19, 2021. The search resulted in only 2 case reports describing patients with acute onset IC with exposure to phenylephrine immediately prior to onset (Table 1). OTC systemic nasal decongestants are alpha-adrenergic agonists that work via arterial vasoconstriction in the nasal mucosa, but they can potentially lead to tissue ischemia of various organs, including cardiac and GI systems. This case serves as a reminder of the important clinical lesson to question all patients’ use of prescribed drugs and OTC products.

Authors, year	Age/ gender	Comorbid conditions	Clinical presentation	OTC phenylephrine containing product	Abnormal laboratory findings	Affected colon	Clinical outcome
Ward et al.	70/F	Hypertension, hyperlipidemia, diverticulosis, smoking	Nausea, vomiting, lower abdominal pain (cramping), hematochezia	Phenylephrine bitartrate 7.8 mg, aspirin 325 mg, and chlorpheniramine maleate 2 mg	White cell count 22.3 x 10⁹/L	Splenic flexure, sigmoid and descending colon	Recovered
El-Alali et al.	34/M	Smokeless tobacco use, BMI 43 kg/m²	Lower abdominal pain (cramping), hematochezia	Phenylephrine HCl 5 mg, acetaminophen 325 mg, and dextromethorphan hydrobromide 10 mg	White cell count 11.9 x 10⁹/L	Splenic flexure, sigmoid and descending colon	Recovered

Table: Table 1. Clinical characteristics of cases of acute ischemic colitis following the use of oral phenylephrine.

Disclosures:
Muhammad Hassan Naeem Goraya indicated no relevant financial relationships.
Junaid Rasul Awan indicated no relevant financial relationships.
Hafiz M. Kashif Saleem indicated no relevant financial relationships.
Faisal Inayat indicated no relevant financial relationships.
Zahid I. Tarar indicated no relevant financial relationships.
Zahra Akhtar indicated no relevant financial relationships.
Gul Nawaz indicated no relevant financial relationships.
Nadeem Hussain indicated no relevant financial relationships.
Adnan Malik indicated no relevant financial relationships.
Muhammad Adnan Zaman indicated no relevant financial relationships.

Muhammad Hassan Naeem Goraya, MBBS¹, Junaid Rasul Awan, MBBS², Hafiz M. Kashif Saleem, MD³, Faisal Inayat, MBBS³, Zahid I. Tarar, MD⁴, Zahra Akhtar, MBBS⁵, Gul Nawaz, MD⁶, Nadeem Hussain, MD³, Adnan Malik, MD⁷, Muhammad Adnan Zaman, MD⁸. P0210 - Acute Ischemic Colitis Secondary to Oral Phenylephrine: An Unusual Adverse Effect of a Common Drug, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.