Review Article

Drug-induced Small Bowel Injury

Shadi Hamdeh; Dejan Micic; Stephen Hanauer


Aliment Pharmacol Ther. 2021;54(44512):1370-1388. 

In This Article


This manuscript provides an updated review of the literature regarding the most common medications associated with small intestinal injury as well as hypothesised mechanisms of injury to allow for early recognition, intervention and management of individuals presenting with possible medication side effects attributed to small intestinal injury. Periodic updates of this work will be required as our understanding of SB disorders and experience with novel medications expands. Drug-induced GI injury is encountered more frequently with the development of novel pharmaceutical agents, together with the ever-advancement in our diagnostic abilities to examine the intestinal lumen. While DIE is increasingly seen and reported, it is still under-recognised. Clinicians should be aware of these potential adverse events, as early recognition is one of the hallmarks in the management of drug toxicities. Different from celiac disease, autoimmune enteropathy or IBD (specifically CD), discontinuation of medication is the treatment of choice and can result in clinical and endoscopic improvements in the majority of cases. In refractory cases, step-up therapy is with additional supportive care (parenteral nutrition) or immunomodulating agents can be indicated. Future work will be required to understand the individual risk factors and (immuno-) pathophysiological mechanisms related to medication effects on the intestine with potential implications for understanding and potential management of other enteropathies.