P2649 - Hydrochlorothiazide Induced Small Bowel Ulceration

Nirali Sheth, DO¹, Anastasia Novikov, MD², Maliyat M. Matin, MD³, Vennis Lourdusamy, MD⁴, Genanew Bedanie, MD⁵, Aaron Walfish, MD⁴, Joshua Aron, MD⁶, Krishna Gurram, MD⁶, Raghav Bansal, MD⁷, Joel Baum, MD^8
1Icahn School of Medicine Mount Sinai - Elmhurst Hospital Center, Rego Park, NY; ²Elmhurst Hospital Center/ Icahn School of Medicine at Mount Sinai, Elmhurst, NY; ³Icahn School of Medicine Mount Sinai - Elmhurst Hospital Center, Elmhurst, NY; ⁴Elmhurst Hospital Center/ Icahn School of Medicine, Elmhurst, NY; ⁵Icahn School of Medicine at Mount Sinai, New York, NY; ⁶Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Elmhurst, Queens, NY; ⁷Elmhurst Hospital Center, Elmhurst, NY; ⁸Icahn School of Medicine at Mount Sinai - Elmhurst Hospital, Queens, NY

Introduction: Small Bowel ulcers can be caused by drug induced enteritis, inflammatory bowel disease, cytomegalovirus, tuberculosis, or intestinal lymphoma. We present a rare case of asymptomatic Hydrochlorothiazide (HTZD) induced ulceration of the small bowel. Drug induced enteritis should be considered in asymptomatic patients when other infectious and inflammatory etiologies have been ruled out.

Case Description/Methods: A 58 year old male with history of chronic venous stasis and Hypertension on HTZD was referred for a screening colonoscopy. He was found to have a two cm ulcer in the distal Terminal Ileum (TI) [Figure 1A]. Biopsies showed active inflammation and ulceration, but no parasites, hyphae, or mycobacteria were detected. Patient denies taking NSAID's or enteric coated potassium. Also denies diarrhea, bloody per rectum, weight loss, or family history of inflammatory bowel disease. HTZD was held for 6 months followed by repeat colonoscopy, which revealed normal terminal ileum, and no further ulcerations [Figure 1B].

Discussion: Drug induced enteritis is commonly seen with NSAID use. Hydrochlorothiazide is a rare cause of small bowel ulceration. While our patient was asymptomatic, there have been few reports of small bowel obstruction secondary to HCTZ induced small bowel ulceration. These patients were also on enteric coated potassium, which our patient was not on. The rising incidence in small bowel ulcerations has been related to administration of thiazide diuretics and potassium for treatment of cardiovascular disease. Our case highlights that patients do not need to be on both thiazides and potassium to develop this complication. It would also appear that the presence of chronic vascular disease serves as a pre-requisite for HCTZ induced necrosis and ulceration. Early diagnosis is important to prevent progression of inflammation and potential for small bowel obstruction.



Disclosures:


Nirali Sheth, DO¹, Anastasia Novikov, MD², Maliyat M. Matin, MD³, Vennis Lourdusamy, MD⁴, Genanew Bedanie, MD⁵, Aaron Walfish, MD⁴, Joshua Aron, MD⁶, Krishna Gurram, MD⁶, Raghav Bansal, MD⁷, Joel Baum, MD⁸. P2649 - Hydrochlorothiazide Induced Small Bowel Ulceration, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.