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Drug-Induced Inflammatory Bowel Disease and IBD-Like Conditions

Dubeau, Marie-France MD; Iacucci, Marietta MD, PhD; Beck, Paul L. MD, PhD; Moran, Gordon W. MD, PhD; Kaplan, Gilaad G. MD, MPH; Ghosh, Subrata MD; Panaccione, Remo MD

doi: 10.1002/ibd.22990
Clinical Review Articles

Abstract: The pathogenesis of inflammatory bowel disease (IBD) is multifactorial and results from an interaction between genetic, immunologic, microbial, and environmental factors. Certain drugs could act as a trigger for the disease and have been implicated in the development of new onset IBD in a number a studies. These relationships are based on case reports and cohort studies, as proving this in the context of randomized controlled trials would be difficult. Drugs that have been linked to causing or worsening IBD include isotretinoin, antibiotics, nonsteroidal antiinflammatory drugs, oral contraceptives, mycophenolate mofetil, etanercept, ipilimumab, and rituximab. Bowel preparation for colonoscopy has also been associated with aphthoid lesions that may be confused with IBD. However, given the source of these reports we have to be cautious in the interpretation of the data before concluding that these drugs trigger IBD and what is being observed is not related to other confounding factors. Different pathogenic mechanisms have been suggested for the different drugs listed above. In order to clarify the confusion a comprehensive literature review was performed with the goal of advancing the knowledge on this subject.

Article first published online 30 May 2012

Inflammatory Bowel Disease Clinic and the Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.

Reprints: Subrata Ghosh, MD, Zone Clinical Department Head, Department of Medicine, University of Calgary, Alberta Health Services –Calgary Zone, Room 929, North Tower, Foothills Medical Centre, 1403, 29th St. NW, Calgary, AB, T2N 2T9, Canada (e-mail:

Received March 19, 2012

Accepted March 26, 2012

© Crohn's & Colitis Foundation of America, Inc.
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