Upper Gastrointestinal Tract Injury Associated With Mycophenolic Acid

Document Type

Conference Proceeding

Publication Date

9-2018

Publication Title

Archives of Pathology and Laboratory Medicine

Abstract

Context: Mycophenolic acid (MPA) is an immunosuppressant drug known to induce injury in the lower gastrointestinal (GI) tract. Only limited cases of injury pattern in the upper GI tract (UGIT) associated with MPA have been studied. This study aims to further study morphologic pattern of UGIT injury in symptomatic patients taking MPA.

Design: Twenty-three patients (12 solid organ transplant, 11 lupus nephritis) who were taking MPA with GI symptoms and had concurrent UGIT biopsies were identified. Eighteen duodenal, 17 gastric, and 8 esophageal biopsies were examined. Apoptosis and patterns of injuries were evaluated. The apoptotic body (AP) counts in duodenal, gastric, and esophageal biopsies from 30 normal cases were standardized for comparison. The cutoff values for apoptosis were ≥2/100 crypts for duodenum, ≥3/100 glands for stomach, and ≥2/10 high-power fields for esophagus.

Results: Among the 23 cases, increased AP counts were present in 11 duodenal biopsies (61%), 6 gastric biopsies (35%), and 4 esophageal biopsies (50%). Additional findings included chronic duodenitis (6 of 18; 33%) and active duodenitis (3 of 18; 17%); reactive gastropathy (4 of 17; 24%); and chronic active gastritis (3 of 18; 17%), reactive esophageal epithelial change (5 of 8; 63%) and active esophagitis (3 of 8; 38%).

Conclusions: Our results are consistent with and support previously reported findings of MPA-associated injury pattern of UGIT. Our data further provide a diagnostic tool to recognize the injury pattern induced by MPA in UGIT biopsies.

Volume

142

Issue

9

First Page

e14

Comments

College of American Pathologist Annual Meeting, October 20-24,2018, Chicago, IL

Last Page

e14

DOI

10.5858/arpa.2018-0293-AB

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