Ischemic colitis associated with pseudoephedrine: Four cases

OBJECTIVE: There is one previously reported case linking ischemic colitis a nd orally administered nasal decongestants containing pseudoephedrine (MEDL INE 1974-1998). We aimed to document an association between pseudoephedrine ingestion and ischemic colitis. METHODS: We reviewed the cases of four women (ages, 37-50 yr) who presented with the sudden onset of colicky abdominal pain followed by hematochezia. Three patients had used medicine containing pseudoephedrine daily for appro ximately 1 wk before admission. The fourth patient had used pseudoephedrine chronically for 6 months. Two patients had no significant past medical his tory. One woman had presented 6 months earlier with ischemic colitis while taking both pseudoephedrine and hormone replacement therapy. This time she presented with ischemic colitis while not taking hormone replacement therap y, but still taking decongestants. Another woman had a history of ulcerativ e colitis, which had been quiescent for 10 yr. One patient had been a smoke r; however, like the other patients she had no evidence of systemic vascula r disease. On colonoscopy, all four patients had colitis, primarily affecti ng the splenic flexure in the anatomical watershed area. Other causes of se gmental colitis, including infectious colitides, pseudomembranous colitis, and Crohn's disease, were not evident. Colonoscopic biopsies were consisten t with ischemic injury. RESULTS: All cases responded to abstinence from pseudoephedrine and medical supportive therapy. None has had a relapse since discontinuing the pseudoe phedrine (8-12 months). CONCLUSIONS:The vasoconstrictive action of pseudoephedrine may predispose s usceptible patients to develop ischemic colitis in the watershed area of th e splenic flexure. Perimenopausal women may be especially susceptible becau se of irregular ovulation. This may result in relative vasoconstriction whe n estrogen levels are low or a hypercoagulable state when estrogen levels a re excessive. (Am J Gastroenterol 1999;94:2430-2434. (C) 1999 by Am. Cell. of Gastroenterology).