Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved]
Angiotensin converting enzyme inhibitors could lead to severe diarrhoea related to microscopic colitis. Few of such cases have been reported before and this serious problem, from a widely used class of drugs in hypertension and heart failure, needs to be more recognised. We describe the case of coll...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
F1000 Research Ltd
2020-09-01
|
| Series: | F1000Research |
| Subjects: | |
| Online Access: | https://f1000research.com/articles/9-1113/v1 |
| _version_ | 1811246570921787392 |
|---|---|
| author | Haseeb Ur Rahman Saad Hasan Stephen Hutchison |
| author_facet | Haseeb Ur Rahman Saad Hasan Stephen Hutchison |
| author_sort | Haseeb Ur Rahman |
| collection | DOAJ |
| description | Angiotensin converting enzyme inhibitors could lead to severe diarrhoea related to microscopic colitis. Few of such cases have been reported before and this serious problem, from a widely used class of drugs in hypertension and heart failure, needs to be more recognised. We describe the case of collagenous colitis related to ramipril use in the following case report. A 74-year-old farmer who had a history of triple vessel coronary artery disease was admitted to district general hospital with non-ST elevation myocardial infarction. He had known alcohol-related chronic pancreatitis with chronic diarrhoea as a complication, which was managed with pancreatic enzyme replacement therapy. However, he developed severe worsening of diarrhoea causing bowel incontinence and nocturnal symptoms during his admission to hospital. The explosive and watery nature of diarrhoea with urgency was so troublesome that it delayed coronary revascularisation and lead him to have significant psychological distress and low mood while nocturnal bowel motions meant he was unable to sleep. He was compliant with his pancreatic enzyme replacement therapy during this period. Infective causes were ruled out by stool microbiology examination and coeliac disease by oesophagogastroscopy and biopsy. It was noticed that he was recently prescribed ramipril that was later stopped as a possible diarrhoea trigger. Diarrhoea started settling immediately and resolved to his baseline within a week. A colonoscopy was performed in the meantime and biopsies demonstrated microscopic colitis (MC). He did not tolerate budesonide well so was stopped. However, a follow-up colonoscopy with biopsy in two months showed resolution of MC. |
| first_indexed | 2024-04-12T14:56:10Z |
| format | Article |
| id | doaj.art-77682d9571974d7a8e921905af03b199 |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-04-12T14:56:10Z |
| publishDate | 2020-09-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-77682d9571974d7a8e921905af03b1992022-12-22T03:28:14ZengF1000 Research LtdF1000Research2046-14022020-09-01928199Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved]Haseeb Ur Rahman0https://orcid.org/0000-0002-5077-2258Saad Hasan1https://orcid.org/0000-0002-0162-8604Stephen Hutchison2Cardiology Department, Nevill Hall Hospital, Abergavenny, Monmouthshire, NP7 7EG, UKCardiology Department, Nevill Hall Hospital, Abergavenny, Monmouthshire, NP7 7EG, UKCardiology Department, Nevill Hall Hospital, Abergavenny, Monmouthshire, NP7 7EG, UKAngiotensin converting enzyme inhibitors could lead to severe diarrhoea related to microscopic colitis. Few of such cases have been reported before and this serious problem, from a widely used class of drugs in hypertension and heart failure, needs to be more recognised. We describe the case of collagenous colitis related to ramipril use in the following case report. A 74-year-old farmer who had a history of triple vessel coronary artery disease was admitted to district general hospital with non-ST elevation myocardial infarction. He had known alcohol-related chronic pancreatitis with chronic diarrhoea as a complication, which was managed with pancreatic enzyme replacement therapy. However, he developed severe worsening of diarrhoea causing bowel incontinence and nocturnal symptoms during his admission to hospital. The explosive and watery nature of diarrhoea with urgency was so troublesome that it delayed coronary revascularisation and lead him to have significant psychological distress and low mood while nocturnal bowel motions meant he was unable to sleep. He was compliant with his pancreatic enzyme replacement therapy during this period. Infective causes were ruled out by stool microbiology examination and coeliac disease by oesophagogastroscopy and biopsy. It was noticed that he was recently prescribed ramipril that was later stopped as a possible diarrhoea trigger. Diarrhoea started settling immediately and resolved to his baseline within a week. A colonoscopy was performed in the meantime and biopsies demonstrated microscopic colitis (MC). He did not tolerate budesonide well so was stopped. However, a follow-up colonoscopy with biopsy in two months showed resolution of MC.https://f1000research.com/articles/9-1113/v1Ramipril microscopic colitis diarrhoea bowel incontinenceeng |
| spellingShingle | Haseeb Ur Rahman Saad Hasan Stephen Hutchison Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved] F1000Research Ramipril microscopic colitis diarrhoea bowel incontinence eng |
| title | Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved] |
| title_full | Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved] |
| title_fullStr | Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved] |
| title_full_unstemmed | Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved] |
| title_short | Case Report: Ramipril and microscopic colitis; a necessary tool of cardiologists can rarely be devastating for patients [version 1; peer review: 2 approved] |
| title_sort | case report ramipril and microscopic colitis a necessary tool of cardiologists can rarely be devastating for patients version 1 peer review 2 approved |
| topic | Ramipril microscopic colitis diarrhoea bowel incontinence eng |
| url | https://f1000research.com/articles/9-1113/v1 |
| work_keys_str_mv | AT haseeburrahman casereportramiprilandmicroscopiccolitisanecessarytoolofcardiologistscanrarelybedevastatingforpatientsversion1peerreview2approved AT saadhasan casereportramiprilandmicroscopiccolitisanecessarytoolofcardiologistscanrarelybedevastatingforpatientsversion1peerreview2approved AT stephenhutchison casereportramiprilandmicroscopiccolitisanecessarytoolofcardiologistscanrarelybedevastatingforpatientsversion1peerreview2approved |