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Intestinal Malabsorption Caused by Aminosalicylic Acid Therapy

Intestinal Malabsorption Caused by Aminosalicylic Acid Therapy Abstract Reversible intestinal malabsorption has been described in association with the oral ingestion of a variety of drugs, notably neomycin sulfate,1 colchicine,2 and the anti-tuberculous agent aminosalicylic acid. A regimen of aminosalicylic acid was initially observed to induce subnormal absorption of cyanocobalamin Co 60 in the presence or absence of added intrinsic factor.3 It has subsequently been reported to provoke steatorrhea in the absence of alteration of the intestinal mucosa by light microscopy.4 The pathogenesis of aminosalicylic acid-induced malabsorption of vitamin B12 and fat were investigated in a patient who initially presented with a neurologic picture consistent with subacute combined degeneration of the spinal cord. She was taking the drug as treatment for presumed disseminated tuberculosis. Patient Summary The patient was a 78-year-old retired nurse who had been treated in a sanitorium 50 years previously for tuberculosis. In November 1965 she developed a nonproductive cough References 1. Jacobson ED, Prior JT, Faloon WW: Malabsorptive syndrome induced by neomycin: Morphologic alterations in the jejunal mucosa. J Lab Clin Med 56:245-250, 1960. 2. Race TF, Paes IC, Faloon WW: Intestinal malabsorption induced by oral colchicine. Amer J Med Sci 259:32-41, 1970.Crossref 3. Heinivaaro 0, Palva IP: Malabsorption and deficiency of vitamin B12 caused by treatment with para-aminosalicylic acid. Acta Med Scand 177:337-341, 1965. 4. Levine RA: Steatorrhea induced by para-aminosalicylic acid. Ann Intern Med 68:1265-1270,1968.Crossref 5. Charache P, Hodkinson BA, Lambiotte B, et al: Genetic and autoimmune features of pernicious anemia: II. Effect of transplacental transfer of antibody to intrinsic factor. Johns Hopkins Med J 122:184-191, 1968. 6. Gottlieb C, Lau KS, Wasserman LR, et al: Rapid charcoal assay for intrinsic factor (I.F.), gastric juice unsaturated B12 binding capacity, antibody to I.F., and serum unsaturated B12 binding capacity. Blood 25:875-884, 1965. 7. Schilling RF: Intrinsic factor studies: II. Effect of gastric juice on urinary excretion of radioactive vitamin B12. J Lab Clin Med 42:860-866, 1953. 8. Halsted CH, Griggs RC, Harris JW: The effect of alcoholism on the absorption of folic acid (H3PGA) evaluated by plasma levels and urine excretion. J Lab Clin Med 69:116-131, 1967. 9. Jeejeebhoy KM, Ramanath P, Mehan KP, et al: A simple method of estimating folic acid absorption (a modified fecal excretion method). J Nucl Med 8:40-49, 1967. 10. Roe JH, Rice EW: A photometric method for the determination of free pentoses in animal tissues. J Biol Chem 173:507-515, 1948. 11. van de Kamer JH, Huinink HB, Weyers HA: Rapid method for the determination of fat in feces. J Biol Chem 177:347-355, 1949. 12. Dahlquist A: Method for assay of intestinal disaccharidases. Anal Biochem 7:18-25, 1964.Crossref 13. Krone CL, Theodor E, Sleisenger MH, et al: Studies on the pathogenesis of malabsorption. Medicine 47:89-106, 1968.Crossref 14. Dole V: A relation between non-esterified fatty acids in plasma and the metabolism of glucose. J Clin Invest 35:150-154, 1956.Crossref 15. Iwata T, Yamasaki K: Enzymatic determination and thin layer chromatography of bile acids in blood. J Biochem 56:424-431, 1964. 16. Hoffman AC: Thin layer absorption chromatography of free and conjugated bile acids on silicic acid. J Lipid Res 3:127;129, 1962. 17. Bayless TM, Rosensweig NS: A racial difference in incidence of lactase deficiency. JAMA 197: 968-972, 1966.Crossref 18. Tygstrup N, Winkler K, Warburg E: Effect of p-aminosalicylic acid on serum cholesterol Lancet 1:503, 1959.Crossref 19. Thompson JB, Hess DR, Poley JR, et al: Intestinal malabsorption induced by para-aminosalicylic acid. Gastroenterology 58:1001, 1970. 20. Toskes PP, Hansell J, Cerda J, et al: Vitamin B12 malabsorption in chronic pancreatic insufficiency. New Eng J Med 284:627-632, 1971.Crossref 21. Webb DI, Chodos RB, Mahar CQ, et al: Mechanism of vitamin B12 malabsorption in patients receiving colchicine. New Eng J Med 279:845-850, 1968.Crossref 22. Lindenbaum J, Lieber CS: Alcohol induced malabsorption of vitamin B12 in man. Nature 224:806, 1969.Crossref 23. Markkanen T, Levanto A, Sallinen V, et al: Folic acid and vitamin B12 in tuberculosis. Scand J Haemat 4:283-291, 1967.Crossref 24. Palva IP, Heinivaara O, Mattila M: Drug-induced malabsorption of vitamin B12: III. Interference of PAS and folic acid in the absorption of vitamin B12. Scand J Haemat 3:149-153, 1966.Crossref 25. Rosenberg IH, Streiff RR, Godwin HA, et al: Absorption of polyglutamate folate: Participation of deconjugating enzymes of the intestinal mucosa. New Eng J Med 280:985-988, 1969.Crossref 26. Paes IC, Searl P, Rubert MW, et al: Intestinal lactase deficiency and saccharide malabsorption during oral neomycin administration. Gastroenterology 53:49-58, 1967. 27. Hoffman AF: A physicochemical approach to the intraluminal phase of fat absorption. Gastroenterology 50:56-65, 1966. 28. Coltart DJ: Malabsorption induced by para-aminosalicylate. Brit Med J 1:825-826, 1969.Crossref 29. van Deest BW, Fordtran JS, Morawski SG: Bile salt and micellar fat concentration in proximal small bowel contents of ileectomy patients. J Clin Invest 47:1314-1324, 1968.Crossref 30. Mekhjian HS, Phillips SF, Hoffman AF: Colonic secretion of water and electrolytes induced by bile acids: Perfusion studies in man. J Clin Invest 50:1569-1577, 1971.Crossref 31. Hoffman AF, Poley JR: Cholestyramine treatment of diarrhea associated with ileal resection. New Eng J Med 281:397-402, 1969.Crossref 32. Czaky TZ, Lassen UV: Active intestinal transport of d-xylose. Biochim Biophys Acta 82:215-217, 1964.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Intestinal Malabsorption Caused by Aminosalicylic Acid Therapy

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Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.03650060123023
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Abstract

Abstract Reversible intestinal malabsorption has been described in association with the oral ingestion of a variety of drugs, notably neomycin sulfate,1 colchicine,2 and the anti-tuberculous agent aminosalicylic acid. A regimen of aminosalicylic acid was initially observed to induce subnormal absorption of cyanocobalamin Co 60 in the presence or absence of added intrinsic factor.3 It has subsequently been reported to provoke steatorrhea in the absence of alteration of the intestinal mucosa by light microscopy.4 The pathogenesis of aminosalicylic acid-induced malabsorption of vitamin B12 and fat were investigated in a patient who initially presented with a neurologic picture consistent with subacute combined degeneration of the spinal cord. She was taking the drug as treatment for presumed disseminated tuberculosis. Patient Summary The patient was a 78-year-old retired nurse who had been treated in a sanitorium 50 years previously for tuberculosis. In November 1965 she developed a nonproductive cough References 1. Jacobson ED, Prior JT, Faloon WW: Malabsorptive syndrome induced by neomycin: Morphologic alterations in the jejunal mucosa. J Lab Clin Med 56:245-250, 1960. 2. Race TF, Paes IC, Faloon WW: Intestinal malabsorption induced by oral colchicine. Amer J Med Sci 259:32-41, 1970.Crossref 3. Heinivaaro 0, Palva IP: Malabsorption and deficiency of vitamin B12 caused by treatment with para-aminosalicylic acid. Acta Med Scand 177:337-341, 1965. 4. Levine RA: Steatorrhea induced by para-aminosalicylic acid. Ann Intern Med 68:1265-1270,1968.Crossref 5. Charache P, Hodkinson BA, Lambiotte B, et al: Genetic and autoimmune features of pernicious anemia: II. Effect of transplacental transfer of antibody to intrinsic factor. Johns Hopkins Med J 122:184-191, 1968. 6. Gottlieb C, Lau KS, Wasserman LR, et al: Rapid charcoal assay for intrinsic factor (I.F.), gastric juice unsaturated B12 binding capacity, antibody to I.F., and serum unsaturated B12 binding capacity. Blood 25:875-884, 1965. 7. Schilling RF: Intrinsic factor studies: II. Effect of gastric juice on urinary excretion of radioactive vitamin B12. J Lab Clin Med 42:860-866, 1953. 8. Halsted CH, Griggs RC, Harris JW: The effect of alcoholism on the absorption of folic acid (H3PGA) evaluated by plasma levels and urine excretion. J Lab Clin Med 69:116-131, 1967. 9. Jeejeebhoy KM, Ramanath P, Mehan KP, et al: A simple method of estimating folic acid absorption (a modified fecal excretion method). J Nucl Med 8:40-49, 1967. 10. Roe JH, Rice EW: A photometric method for the determination of free pentoses in animal tissues. J Biol Chem 173:507-515, 1948. 11. van de Kamer JH, Huinink HB, Weyers HA: Rapid method for the determination of fat in feces. J Biol Chem 177:347-355, 1949. 12. Dahlquist A: Method for assay of intestinal disaccharidases. Anal Biochem 7:18-25, 1964.Crossref 13. Krone CL, Theodor E, Sleisenger MH, et al: Studies on the pathogenesis of malabsorption. Medicine 47:89-106, 1968.Crossref 14. Dole V: A relation between non-esterified fatty acids in plasma and the metabolism of glucose. J Clin Invest 35:150-154, 1956.Crossref 15. Iwata T, Yamasaki K: Enzymatic determination and thin layer chromatography of bile acids in blood. J Biochem 56:424-431, 1964. 16. Hoffman AC: Thin layer absorption chromatography of free and conjugated bile acids on silicic acid. J Lipid Res 3:127;129, 1962. 17. Bayless TM, Rosensweig NS: A racial difference in incidence of lactase deficiency. JAMA 197: 968-972, 1966.Crossref 18. Tygstrup N, Winkler K, Warburg E: Effect of p-aminosalicylic acid on serum cholesterol Lancet 1:503, 1959.Crossref 19. Thompson JB, Hess DR, Poley JR, et al: Intestinal malabsorption induced by para-aminosalicylic acid. Gastroenterology 58:1001, 1970. 20. Toskes PP, Hansell J, Cerda J, et al: Vitamin B12 malabsorption in chronic pancreatic insufficiency. New Eng J Med 284:627-632, 1971.Crossref 21. Webb DI, Chodos RB, Mahar CQ, et al: Mechanism of vitamin B12 malabsorption in patients receiving colchicine. New Eng J Med 279:845-850, 1968.Crossref 22. Lindenbaum J, Lieber CS: Alcohol induced malabsorption of vitamin B12 in man. Nature 224:806, 1969.Crossref 23. Markkanen T, Levanto A, Sallinen V, et al: Folic acid and vitamin B12 in tuberculosis. Scand J Haemat 4:283-291, 1967.Crossref 24. Palva IP, Heinivaara O, Mattila M: Drug-induced malabsorption of vitamin B12: III. Interference of PAS and folic acid in the absorption of vitamin B12. Scand J Haemat 3:149-153, 1966.Crossref 25. Rosenberg IH, Streiff RR, Godwin HA, et al: Absorption of polyglutamate folate: Participation of deconjugating enzymes of the intestinal mucosa. New Eng J Med 280:985-988, 1969.Crossref 26. Paes IC, Searl P, Rubert MW, et al: Intestinal lactase deficiency and saccharide malabsorption during oral neomycin administration. Gastroenterology 53:49-58, 1967. 27. Hoffman AF: A physicochemical approach to the intraluminal phase of fat absorption. Gastroenterology 50:56-65, 1966. 28. Coltart DJ: Malabsorption induced by para-aminosalicylate. Brit Med J 1:825-826, 1969.Crossref 29. van Deest BW, Fordtran JS, Morawski SG: Bile salt and micellar fat concentration in proximal small bowel contents of ileectomy patients. J Clin Invest 47:1314-1324, 1968.Crossref 30. Mekhjian HS, Phillips SF, Hoffman AF: Colonic secretion of water and electrolytes induced by bile acids: Perfusion studies in man. J Clin Invest 50:1569-1577, 1971.Crossref 31. Hoffman AF, Poley JR: Cholestyramine treatment of diarrhea associated with ileal resection. New Eng J Med 281:397-402, 1969.Crossref 32. Czaky TZ, Lassen UV: Active intestinal transport of d-xylose. Biochim Biophys Acta 82:215-217, 1964.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1972

References