lymphocytic colitis on sertraline

[liquidshadow22]

have a patient who was started on zoloft 50 mg , was having acutely worsening diarrhea over 4-8 weeks, was dx with c. diff and then had a colonoscopy dx with lymphocytic colitis. GI Doctor believes it is related to sertraline.

I found one articel report of this in the literature (dont have acceess to this) . Is this actually possible. I have never heard of this.

Lakartidningen

. 2012 Jan 11-17;109(1-2):38.

[Possible connection between lymphocytic colitis and sertraline treatment]​

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[birchswing]

You can paste the link in Google translate to read it in English:

Möjligt samband mellan lymfocytär kolit och sertralinbehandling

Lymfocytär kolit är en så kallad mikroskopisk kolit, där mikroskopiundersökning av biopsier krävs för att påvisa de patologiska förändringarna i tarmslemhinnan. Kliniskt kännetecknas mikroskopisk kolit av långvarig, vanligen oblodig, diarré [1]. Även om patogenesen vid lymfocytär kolit ännu är...

lakartidningen.se

I speak Swedish, but even I'd put that in Google translate. My Swedish isn't that good.

It looks like it's just an article discussing this study:

Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients - PMC

Background: Lymphocytic colitis is characterised by chronic diarrhoea and specific microscopic changes in a macroscopically normal colonic mucosa. We report clinical features and treatment outcome in a large patient cohort. Methods: Patients were ...

www.ncbi.nlm.nih.gov

 

[forchinet121]

Interesting haven’t heard of this before

 

[Crayola227]

Well, just about anything can cause eosinophilic esophagitis, I sorta wonder if something similar can happen here?

Googling however confirms EoE as being an allergic reaction to just about anything, and it seems the lymphocytic colitis is rarer and less understood.

My main takeaway is the immune system can do just about anything in response to just about anything. A drug (sertraline) and lymphocytes in the colon? Sure. Or it was something else. Or nothing. Hard to say without knowing more.

 

[Penguin10]

Had not heard this before, interesting.

This 2012 statement (which is cited by UpToDate's article) lists sertraline and clozapine as high likelihood to trigger MC, carbamazepine, duloxetine, and paroxetine as intermediate likelihood (need to look at Table 4 in the PDF):

Microscopic colitis: Current status, present and future challenges: Statements of the European Microscopic Colitis Group

They cite this paywalled 2007 paper which references SSRIs in the abstract:

Drug consumption and the risk of microscopic colitis - PubMed

and this 2013 paper reporting a case control study of 128 patients with MC that cites an odds ratio of 17.5 for sertraline:

Epidemiological risk factors in microscopic colitis: a prospective case-control study - PubMed

Seems like there are numerous possible triggers and interacting factors but decent argument to implicate sertraline.

 

[Stagg737]

I don't know enough about microscopic/lymphocytic colitis, but is this not something that can be helped by...stopping sertraline?

Also, the abstract for the last source makes it seem like the OR of 17.5 for sertraline was in people with associated autoimmune disorders. Didn't read through the article, but doesn't seem particularly shocking that someone with an autoimmune disorder (likely GI given the "associated" specifier) would be more likely to develop coliltis from the SSRI which most commonly causes GI distress...