**Authors:** Poor A, Braman SS **Journal:** Lung **Year of Publication:** 2018 **Volume and Page Numbers:** Volume 196, Pages 373–375
**Abstract:** Pneumatosis intestinalis (PI) is a condition characterized by the presence of gas within the wall of the intestine, which can be associated with various underlying pathologies, including ischemia, infection, and certain medications. This case report discusses the occurrence of pneumatosis intestinalis in a patient undergoing treatment with Nintedanib, a tyrosine kinase inhibitor primarily used for the treatment of idiopathic pulmonary fibrosis (IPF). The authors aim to highlight the potential gastrointestinal side effects of Nintedanib, particularly the rare but serious complication of PI
. **Introduction:** Nintedanib is an oral medication that inhibits multiple tyrosine kinases involved in the pathogenesis of fibrotic diseases, including IPF. While the drug is effective in slowing disease progression, it has been associated with various adverse effects, including gastrointestinal complications. Pneumatosis intestinalis, although infrequent, is a serious condition that can lead to significant morbidity and mortality if not recognized and managed promptly.
**Case Presentation:** The report details the clinical course of a patient who developed pneumatosis intestinalis while receiving Nintedanib. The patient presented with abdominal pain and distension, prompting further investigation through imaging studies, which revealed the presence of gas within the intestinal wall. The authors discuss the diagnostic approach, including the use of computed tomography (CT) scans, which are critical in identifying PI and differentiating it from other conditions that may present similarly.
**Discussion:** The authors discuss the pathophysiology of pneumatosis intestinalis, emphasizing the role of mucosal injury and gas-producing bacteria in the development of this condition. They also review the existing literature on the gastrointestinal side effects of Nintedanib, noting that while diarrhea is a common adverse effect, other complications such as PI are less frequently reported. The discussion includes a review of the mechanisms by which Nintedanib may contribute to gastrointestinal injury, including its effects on vascular permeability and mucosal integrity.
**Conclusion:** The case underscores the importance of monitoring patients on Nintedanib for gastrointestinal symptoms, particularly those that may suggest pneumatosis intestinalis. Clinicians should maintain a high index of suspicion for this rare but serious complication, as early recognition and management are crucial for patient outcomes. The authors call for further research to better understand the incidence and mechanisms of gastrointestinal complications associated with Nintedanib and other tyrosine kinase inhibitors.
**References:**
1. Poor A, Braman SS. Pneumatosis intestinalis associated with the tyrosine kinase inhibitor Nintedanib. Lung. 2018; 196: 373–5.
2. (Additional references related to pneumatosis intestinalis, Nintedanib, and gastrointestinal complications may be included here to provide a comprehensive overview of the topic.)