DOI: 10.12890/2024_004826
Selective serotonin reuptake inhibitors and solitary rectal ulcer syndrome: a bloody relationship
Authors
elias.fiani@hotmail.com
Keywords
Solitary rectal ulcer syndrome, SSRIs, gastrointestinal bleed, platelet dysfunctionAbstract
Introduction: Solitary rectal ulcer syndrome (SURS) is a poorly understood and uncommon benign disorder of the lower gastrointestinal tract. It presents with various symptoms, often misinterpreted as inflammatory bowel disease. To date, there is no association between the use of selective serotonin reuptake inhibitors (SSRIs) and SURS.
Case description: A 29-year-old male on paroxetine for six months and with a non-contributory surgical history presented to the clinic due to three months of haematochezia, abdominal pain and mucoid discharge. Physical examination and a review of systems were unremarkable; a colonoscopy demonstrated a suspicious ulcerated lesion in the rectum, which was identified as SURS on biopsy. The patient was advised lifestyle and dietary modifications. In addition, paroxetine was discontinued, and patient was switched to venlafaxine, a serotonin–norepinephrine reuptake inhibitor. Subsequently, the patient’s symptoms resolved gradually, and he did not report any signs of recurrence on follow-up.
Conclusion: Literature confirms that SSRIs can increase the occurrence of GI ulceration yet focuses specifically on upper gastrointestinal bleeding rather than rectal bleeding. This finding raises the need for further research.
References
- Abusharifah O, Bokhary RY, Mosli MH, Saadah OI. Solitary rectal ulcer syndrome in children and adolescents: a descriptive clinicopathologic study. Int J Clin Exp Pathol 2021;14:399–407.
- Sadeghi A, Biglari M, Forootan M, Adibi P. Solitary rectal ulcer syndrome: a narrative review. Middle East J Dig Dis 2019;11:129–134.
- Liu Y, Chen Z, Dou L, Yang Z, Wang G. Solitary rectal ulcer syndrome is not always ulcerated: a case report. Medicina (Kaunas) 2022;58:1136.
- Forootan M, Darvishi M. Solitary rectal ulcer syndrome: a systematic review. Medicine (Baltimore) 2018;97:e0565. Erratum in: Medicine (Baltimore) 2019;98:e14662.
- Zhu QC, Shen RR, Qin HL, Wang Y. Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies. World J Gastroenterol 2014;20:738–744.
- Paton C, Ferrier IN. SSRIs and gastrointestinal bleeding. BMJ 2005;331:529–530.
- Song HR, Jung YE, Wang HR, Woo YS, Jun TY, Bahk WM. Platelet count alterations associated with escitalopram, venlafaxine and bupropion in depressive patients. Psychiatry Clin Neurosci 2012;66:457–459.
- Mercado CP, Kilic F. Molecular mechanisms of SERT in platelets: regulation of plasma serotonin levels. Mol Interv 2010;10:231–241.
- Yuet WC, Derasari D, Sivoravong J, Mason D, Jann M. Selective serotonin reuptake inhibitor use and risk of gastrointestinal and intracranial bleeding. J Am Osteopath Assoc 2019;119:102–111.
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method of estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–245.
- Gouriou C, Siproudhis L, Chambaz, M, Ropert A, Wallenhorst T, Merlini-l’Héritier A, et al. Solitary rectal ulcer syndrome in 102 patients: do different phenotypes make sense? Dig Liver Dis 2021;53:190–195.
