Sudhir Reddy. Pasham, MD1, Saisree Reddy Adla Jala, MD2, Shri Jai Kirshan Ravi, MD1, Sravan Ponnekanti, MD1, Rewanth Katamreddy, MD3, Michael Georgetson, MD1 1Guthrie Robert Packer Hospital, Sayre, PA; 2Centinela Hospital Medical Center, Los Angeles, CA; 3Saint Michael’s Medical Center, Newark, NJ
Introduction: Total annual incidence of ischemic colitis [IC] 15.6 - 17.7 per 100,000. IC untreated can lead to bowel perforation, peritonitis, persistent bleeding, protein-losing Colopathy and symptomatic intestinal strictures. predisposition to progress, IC mortality is high. Majority of cases are treated conservatively, with needed 20% surgical intervention. Sumatriptan is a 5-HT1B/1D agonist, from Triptans first of its class, well known for treating, migraine attacks.
Case Description/Methods: A 42 y/o F with PMH of Migraine presented with complaint of bright red blood per rectum [ BRBPR ],cramps in her lower abdomen, vomiting and nausea for 3 days. Abdominal pain crampy, lower abdominal quadrants, with severity of 7/10, 3 days in duration, aggravated with food intake and relieved by bowel rest,associated with diarrhea. Hemoglobin was at her baseline. EGD: No upper gastrointestinal bleeding. Five years ago, colonoscopy shown hyperplastic colonic polyps. Having a history of chronic constipation, predisposed her for Ischemic colitis. She has been using inhalational sumatriptan every 2 hours during the migraine episodes, since last 7 years. On admission, her vitals were stable Colonoscopy : Congested (Odematous) & Ulcerated mucosa in the descending colon. GI recommended the patient to avoid sumatriptan, and one week later patient acknowledged, that her symptoms including Nausea, Vomiting, abdominal pain, BRBPR resolved & advised to follow up patient, in the GI office as an outpatient for repeat colonoscopy upon clinical assessment.
Discussion: Sumatriptan, first in its class, known for its extensive use for migraines since 1990’s, by causing vasoconstriction of cerebral blood vessels and by decreasing the neurogenic inflammation. Sumatriptan action on its receptors 5HTB1/D1 receptors, is not limited to CNS, acts on other vascular bed coronary, mesenteric blood vessels by vasoconstriction and on peripheral vasoconstriction, leading to hypertension. The FDA adverse event reporting system [FAERS] data of 5-year period, March 2008-March 2013, shown 19 “IC” as the main adverse event out of 10,252 sumatriptan-associated events, representing all organ systems which includes ischemic colitis. For any individual on medication for migraine experiencing abdominal symptoms, a high index of suspicion needed for sumatriptan related ischemic colitis.
