Correlation of abnormal histology with endoscopic findings among mycophenolate mofetil treated patients

摘要

AIM To describe all abnormal histological findings and their associated endoscopic presentation in patients using mycophenolate mofetil(MMF).METHODS A retrospective review of all individuals prescribed MMF within 6 mo of a colonoscopy or flexible sigmoidoscopy between 07/2009 and 09/2015 was performed within Northwell Health system.Records were analyzed for age,gender,procedure indication,MMF indication,and both gross and microscopic findings.Only reports with abnormal histology were included.RESULTS One hundred and eighty-four procedures from 170 patients were found,of which 39 met inclusion criteria.Fifty-one point three percent were female.MMF was used for solid organ transplant in 71.8%.Diarrhea was the indication for 71.8% of colonoscopies.Fiftynine percent of reports revealed gross and microscopic abnormalities while 41.0% had only microscopic findings.Only 11 patients' reports(28.2%) indicated a specific histopathology of MMF colitis.Among the entire group,only 23.1% of abnormal histology was isolated proximal to the splenic flexure.CONCLUSION Our results demonstrate a high rate of left sided disease and microscopic findings without gross mucosal abnormalities among patients using MMF.Also,a broader definition of MMF-colonopathy may be appropriate,with a majority of our abnormal histology falling outside of the more narrowly defined MMF-colitis category.Given the high frequency of isolated microscopic abnormalities and distal disease,sigmoidoscopy with random biopsies may be an appropriate,less invasive initial endoscopic examination in selected MMF patients.