{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:09:22Z","timestamp":1780088962330,"version":"3.54.0"},"reference-count":48,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T00:00:00Z","timestamp":1665100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Alpha-glucosidase inhibitor (\u03b1GIs)-induced pneumatosis intestinalis (PI) has been narrated in case reports but never systematically investigated. This study aimed to investigate the concurrency of PI and \u03b1GIs. A literature search was performed in PubMed, Google Scholar, WorldCat, and the Directory of Open-Access Journals (DOAJ) by using the keywords \u201cpneumatosis intestinalis\u201d, \u201calpha-glucosidase inhibitors\u201d, and \u201cdiabetes\u201d. In total, 29 cases of \u03b1GIs-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 \u03b1GI 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 \u03b1GIs-induced PI. Conservative therapy is recommended when treating \u03b1GIs-induced PI.<\/jats:p>","DOI":"10.3390\/jcm11195918","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T23:39:31Z","timestamp":1665272371000},"page":"5918","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7513-1481","authenticated-orcid":false,"given":"Blake J.","family":"McKinley","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Santiago","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Rocky Vista University College of Osteopathic Medicine, Ivins, UT 84738, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8931-4326","authenticated-orcid":false,"given":"Christi","family":"Pak","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Rocky Vista University College of Osteopathic Medicine, Ivins, UT 84738, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nataly","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Rocky Vista University College of Osteopathic Medicine, Ivins, UT 84738, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2332-5820","authenticated-orcid":false,"given":"Qing","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Rocky Vista University College of Osteopathic Medicine, Ivins, UT 84738, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,7]]},"reference":[{"key":"ref_1","unstructured":"Im, J., and Anjum, F. (2022, August 01). Pneumatosis Intestinalis, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK564381\/."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gazzaniga, G., Villa, F., Tosi, F., Pizzutilo, E.G., Colla, S., D\u2019Onghia, S., Sanza, G.D., Fornasier, G., Gringeri, M., and Lucatelli, M.V. (2022). Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review. Cancers, 14.","DOI":"10.3390\/cancers14071666"},{"key":"ref_3","first-page":"1747","article-title":"Pneumatosis intestinalis: A review","volume":"90","author":"Heng","year":"1995","journal-title":"Am. J. Gastroenterol."},{"key":"ref_4","first-page":"510","article-title":"Segmental pneumatosis cystoides coli: Computed tomography-facilitated diagnosis","volume":"108","author":"Ksiadzyna","year":"2016","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"601872","DOI":"10.3389\/fmed.2021.601872","article-title":"The Role of Hyperbaric Oxygen Therapy in Pneumatosis Cystoides Intestinalis-A Scoping Review","volume":"8","year":"2021","journal-title":"Front. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.radcr.2022.01.062","article-title":"Pneumatosis intestinalis: Not always bowel ischemia","volume":"17","author":"Lee","year":"2022","journal-title":"Radiol. Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e556","DOI":"10.1002\/ams2.556","article-title":"Clinical characteristics and prediction of the asymptomatic phenotype of pneumatosis intestinalis in critically ill patients: A retrospective observational study","volume":"7","author":"Sato","year":"2020","journal-title":"Acute Med. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.2214\/AJR.06.1309","article-title":"Pneumatosis intestinalis in the adult: Benign to life-threatening causes","volume":"188","author":"Ho","year":"2007","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"289","DOI":"10.5217\/ir.2019.00073","article-title":"Presentation and outcomes among inflammatory bowel disease patients with concurrent pneumatosis intestinalis: A case series and systematic review","volume":"18","author":"Gao","year":"2020","journal-title":"Intest. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1148\/rg.2016150132","article-title":"Imaging of Drug-induced Complications in the Gastrointestinal System","volume":"36","author":"McGettigan","year":"2016","journal-title":"RadioGraphics"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ohmiya, N., Hirata, I., Sakamoto, H., Morishita, T., Saito, E., Matsuoka, K., Nagaya, T., Nagata, S., Mukae, M., and Sano, K. (2022). Multicenter epidemiological survey of pneumatosis intestinalis in Japan. BMC Gastroenterol., 22.","DOI":"10.1186\/s12876-022-02343-5"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.2169\/internalmedicine.49.3634","article-title":"Pneumatosis cystoides intestinalis induced by the \u03b1-glucosidase inhibitor miglitol","volume":"49","author":"Kojima","year":"2010","journal-title":"Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"366","DOI":"10.2337\/diacare.22.2.366a","article-title":"Pneumatosis cystoides intestinalis after treatment with an alpha-glucosidase inhibitor","volume":"22","author":"Hayakawa","year":"1999","journal-title":"Diabetes Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/00004836-200208000-00020","article-title":"Regression of pneumatosis cystoides intestinalis after discontinuing of alpha-glucosidase inhibitor administration","volume":"35","author":"Yanaru","year":"2002","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_15","first-page":"339","article-title":"Pneumatosis coli induced by acarbose administration for diabetes mellitus. Case report and literature review","volume":"52","author":"Furio","year":"2006","journal-title":"Minerva Gastroenterol. Dietol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"393","DOI":"10.5152\/tjg.2021.20588","article-title":"Population-Based Study of the Clinical Characteristics and Risk Factors of Ischemic Colitis","volume":"32","author":"Wu","year":"2021","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.fjs.2011.08.011","article-title":"Pneumatosis cystoides intestinalis","volume":"44","author":"Tseng","year":"2011","journal-title":"Formos. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Takase, A., Akuzawa, N., Naitoh, H., and Aoki, J. (2017). Pneumatosis intestinalis with a benign clinical course: A report of two cases. BMC Res. Notes, 10.","DOI":"10.1186\/s13104-017-2647-0"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1038\/ajg.2017.88","article-title":"Pneumatosis Cystoides Coli Related to Acarbose Treatment","volume":"112","author":"Liao","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wang, Y.J., Wang, Y.M., Zheng, Y.M., Jiang, H.Q., and Zhang, J. (2018). Pneumatosis cystoides intestinalis: Six case reports and a review of the literature. BMC Gastroenterol., 18.","DOI":"10.1186\/s12876-018-0794-y"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1148\/radiol.2019182186","article-title":"Pneumatosis Cystoides Intestinalis Secondary to Use of an \u03b1-Glucosidase Inhibitor","volume":"290","author":"Lin","year":"2019","journal-title":"Radiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"826","DOI":"10.2169\/internalmedicine.39.826","article-title":"Paralytic ileus accompanied by pneumatosis cystoides intestinalis after acarbose treatment in an elderly diabetic patient with a history of heavy intake of maltitol","volume":"39","author":"Azami","year":"2000","journal-title":"Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2169\/internalmedicine.45.1330","article-title":"Pneumatosis cystoides intestinalis after alpha-glucosidase inhibitor treatment in a patient with interstitial pneumonitis","volume":"45","author":"Hisamoto","year":"2006","journal-title":"Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2169\/internalmedicine.46.6076","article-title":"Fulminant pneumatosis intestinalis in a patient with diabetes mellitus and minimal change nephrotic syndrome","volume":"46","author":"Maeda","year":"2007","journal-title":"Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s10067-005-0179-9","article-title":"Additive contribution of multiple factors in the development of pneumatosis intestinalis: A case report and review of the literature","volume":"26","author":"Saito","year":"2007","journal-title":"Clin. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6087","DOI":"10.3748\/wjg.14.6087","article-title":"Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: A case report and review of the literature","volume":"14","author":"Tsujimoto","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"9216","DOI":"10.4076\/1752-1947-3-9216","article-title":"Pneumatosis cystoides intestinalis of the ascending colon related to acarbose treatment: A case report","volume":"3","author":"Vogel","year":"2009","journal-title":"J. Med. Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"415","DOI":"10.3109\/s10165-010-0407-2","article-title":"Pneumatosis cystoides intestinalis in neuropsychiatric systemic lupus erythematosus with diabetes mellitus: Case report and literature review","volume":"21","author":"Shimojima","year":"2011","journal-title":"Mod. Rheumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1007\/s00595-012-0184-y","article-title":"Successful conservative treatment of pneumatosis intestinalis associated with intraperitoneal free air: Report of a case","volume":"42","author":"Imai","year":"2012","journal-title":"Surg. Today."},{"key":"ref_30","first-page":"123","article-title":"Successfully treated pneumatosis cystoides intestinalis with pneumoperitoneum onset in a patient administered \u03b1-glucosidase inhibitor","volume":"67","author":"Tanabe","year":"2013","journal-title":"Acta Med. Okayama"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"691","DOI":"10.2169\/internalmedicine.53.1789","article-title":"Do alpha-glucosidase inhibitors have the potential to induce portal venous gas? -Two clinical case reports","volume":"53","author":"Makiyama","year":"2014","journal-title":"Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s13340-014-0158-y","article-title":"Pneumatosis cystoides intestinalis related to \u03b1-glucosidase inhibitor treatment in a polymyalgia rheumatica patient with diabetes mellitus","volume":"5","author":"Ogo","year":"2014","journal-title":"Diabetol. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.2169\/internalmedicine.54.4255","article-title":"A Rare Case of Benign Pneumatosis Intestinalis with Portal Venous Gas and Pneumoperitoneum Induced by Acarbose","volume":"54","author":"Rottenstreich","year":"2015","journal-title":"Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.2169\/internalmedicine.56.7877","article-title":"Four Cases of Pneumatosis Cystoides Intestinalis Complicated by Connective Tissue Diseases","volume":"56","author":"Suzuki","year":"2017","journal-title":"Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ling, F., Guo, D., and Zhu, L. (2019). Pneumatosis cystoides intestinalis: A case report and literature review. BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-1087-9"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00384-020-03549-3","article-title":"Pneumatosis cystoides intestinalis induced by the alpha-glucosidase inhibitor complicated from sigmoid volvulus in a diabetic patient","volume":"35","author":"Police","year":"2020","journal-title":"Int. J. Colorectal. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s13730-020-00522-5","article-title":"Peritoneal dialysis-related peritonitis complicated with nonocclusive mesenteric ischemia","volume":"10","author":"Oda","year":"2021","journal-title":"CEN Case Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1016\/j.transproceed.2021.02.006","article-title":"Pneumatosis Intestinalis After Living Donor Lung Transplantation Associated With Alpha-Glucosidase Inhibitor Treatment: A Case Report","volume":"53","author":"Otsuka","year":"2021","journal-title":"Transplant. Proc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1136\/gut.20.11.1008","article-title":"Breath hydrogen in pneumatosis cystoides intestinalis","volume":"20","author":"Gillon","year":"1979","journal-title":"Gut"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"610","DOI":"10.3109\/s10165-011-0551-3","article-title":"Three cases of pneumatosis intestinalis presenting in autoimmune diseases","volume":"22","author":"Sagara","year":"2012","journal-title":"Mod. Rheumatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1378\/chest.105.3.929","article-title":"Pneumatosis intestinalis and active cytomegaloviral infection after lung transplantation. Groningen Lung Transplant Group","volume":"105","author":"Mannes","year":"1994","journal-title":"Chest"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"733","DOI":"10.2214\/ajr.180.3.1800733","article-title":"Pneumatosis intestinalis in patients with ischemia: Correlation of CT findings with viability of the bowel","volume":"180","author":"Kernagis","year":"2003","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s11605-009-1143-9","article-title":"Management algorithm for pneumatosis intestinalis and portal venous gas: Treatment and outcome of 88 consecutive cases","volume":"14","author":"Wayne","year":"2010","journal-title":"J. Gastrointest. Surg."},{"key":"ref_44","unstructured":"Bischoff, H. (1995). Pharmacology of \u03b1-Glycosidase Inhibitors Drugs in Development \u03b1-Glycosidase Inhibition Potential Use in Diabetes, Neva."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S0168-8227(00)00231-X","article-title":"Improved glycaemic control with miglitol in inadequately-controlled type 2 diabetics","volume":"51","author":"Standl","year":"2001","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_46","first-page":"3023","article-title":"Voglibose: An alpha glucosidase inhibitor","volume":"7","author":"Dabhi","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1111\/ans.16772","article-title":"Clinical characteristics of patients with pneumatosis intestinalis","volume":"91","author":"Fujii","year":"2021","journal-title":"ANZ J. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"337","DOI":"10.21037\/atm-20-8154","article-title":"Predictors and risk factors for intestinal necrosis in patients with mesenteric ischemia","volume":"9","author":"Zhao","year":"2021","journal-title":"Ann. Transl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/19\/5918\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:47:48Z","timestamp":1760143668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/19\/5918"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,7]]},"references-count":48,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcm11195918"],"URL":"https:\/\/doi.org\/10.3390\/jcm11195918","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,7]]}}}