Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus

Abstract

Alpha-glucosidase inhibitor (αGIs)-induced pneumatosis intestinalis (PI) has been narrated in case reports but never systematically investigated. This study aimed to investigate the concurrency of PI and αGIs. A literature search was performed in PubMed, Google Scholar, WorldCat, and the Directory of Open-Access Journals (DOAJ) by using the keywords "pneumatosis intestinalis", "alpha-glucosidase inhibitors", and "diabetes". In total, 29 cases of αGIs-induced PI in 28 articles were included. There were 11 men, 17 women, and one undefined sex, with a median age of 67. The most used αGI was voglibose (44.8%), followed by acarbose (41.4%) and miglitol (6.8%). Nine (31%) patients reported concomitant use of prednisone/prednisolone with or without immunosuppressants. The main symptoms were abdominal pain (54.5%) and distention (50%). The ascending colon (55.2%) and the ileum (34.5%) were the most affected. Nineteen (65.5%) patients had comorbidities. Patients with comorbidities had higher rates of air in body cavities, the portal vein, extraintestinal tissues, and the wall of the small intestine. Only one patient was found to have non-occlusive mesenteric ischemia. Twenty-five patients were treated with conservative therapy alone, and two patients received surgical intervention. All patients recovered. In conclusion, comorbidities, glucocorticoids, and immunosuppressants aggravate αGIs-induced PI. Conservative therapy is recommended when treating αGIs-induced PI.

Keywords: acarbose; alpha-glucosidase inhibitors; comorbidities; concomitant drugs; diabetes; immunosuppressants; miglitol; pneumatosis intestinalis; prednisone; voglibose.

Figure 1

Literature search flow. Legend: A total of 151 abstracts were found from four databases of Pubmed, WorldCat, Google Scholar, and DOAJ. Twenty-eight articles met the inclusion criteria.

Figure 2

Overview of the symptoms of αGIs-induced PI. Legend: abdominal pain and distention were the most common symptoms, followed by diarrhea and bloody stool.

Figure 3

Possible mechanisms of αGIs-induced PI. Legend: There are multiple contributors to the development of αGIs-induced PI: increased production of intestinal gas, hypomotility of the gastrointestinal tract, weakened intestinal mucosa and wall, and/or air carried from the lungs. Abbreviations: IBD: inflammatory bowel disease; GI: the gastrointestinal tract.