GI Mucosal Injury and Bleeding: Association with Sevelamer Crystals

Many medications have been listed as causes for GI mucosal injury. Sevelamer, a phosphate binder used in patients with CKD, has been studied recently as a possible cause. The first case report of lower gastrointestinal bleeding due to stercoral ulceration caused by sevelamer was described in 2008. Since then there have been a few case reports and studies regarding the same, although larger studies are required to prove causation. In this paper, we present a patient with lower GI bleed, whose colonoscopy revealed an ulcer, with biopsy report showing sevelamer crystals, and no atypia, granulomas, or evidence of acute inflammation. We discuss various reports of sevelamer and GI injury, its histological appearance and differentiation from other medications also known to cause GI damage.