title: Lansoprazole-induced microscopic colitis: an increasing problem? Results of a prospecive case-series and systematic review of the literature.
abstract: BACKGROUND
  Microscopic colitis (MC), comprising lymphocytic and collagenous colitis (LC, CC), causes chronic diarrhoea. Lansoprazole can cause MC. Likelihood criteria defining the causative relationship between drugs and MC have not been applied to lansoprazole, nor has lansoprazole-related-MC been characterized.
  
  
  OBJECTIVE
  To analyse a series of lansoprazole-related MC cases, and characterize lansoprazole-related CC and LC.
  
  
  METHODS
  Cases were diagnosed over 23 months and causal relationship evaluated by established likelihood criteria. A systematic Medline search was conducted and publications analysed.
  
  
  RESULTS
  Eight patients had lansoprazole-related MC. In all cases chronological and causality likelihood scores supported lansoprazole causative role. Discontinuation determined resolution without further treatment. Twenty-five cases of lansoprazole-related MC from 10 publications were grouped with the present series, and differences between CC and LC analysed. CC cases had more macroscopic alterations at colonoscopy (72.2 vs. 6.6%; p=0.0002). Time between lansoprazole start and symptoms onset was longer for CC (median 60 vs. 28 days; p=0.03).
  
  
  CONCLUSIONS
  Peculiar features of lansoprazole-related CC were described through the analysis of a newly diagnosed lansoprazole-related MC series in which the causative role of lansoprazole was for the first time defined by established likelihood criteria, and by pooled evaluation with other cases retrieved by a systematic literature review.
authors.affiliation: Digestive and Liver Disease Unit, II Medical School, University Sapienza, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Capurso
authors.forename: Massimo
authors.initials: M
authors.lastname: Marignani
authors.forename: Fabio
authors.initials: F
authors.lastname: Attilia
authors.forename: Massimo
authors.initials: M
authors.lastname: Milione
authors.forename: Cristina
authors.initials: C
authors.lastname: Colarossi
authors.forename: Costantino
authors.initials: C
authors.lastname: Zampaletta
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000009:adverse effects*; D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000009:adverse effects*; D046729:Colitis, Collagenous / Q000139:chemically induced* / Q000150:complications; D046730:Colitis, Lymphocytic / Q000139:chemically induced* / Q000150:complications; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D064747:Lansoprazole