What is melanosis coli?
Chronic laxative use deposits dark pigment in the lining layers of the large intestine, causing melanosis coli.
Melanosis coli is a condition usually associated with
chronic laxative use in which dark pigment is deposited in
the lamina propria
(one of the lining layers) of the large intestine
(colon). The pigment deposition results in a characteristic dark brown to black
discoloration of the lining of the large intestine. This condition is sometimes called
pseudomelanosis coli because the pigment deposits consist of a pigment known as
lipofuscin and do not contain melanin as implied by the term "melanosis."
Lipofuscin is a cellular pigment that forms when cells are destroyed, often
called "wear and tear" pigment that can be found throughout the body.
The dark color of the intestinal lining may be uniform
or patterned, and the discoloration may be slight or very pronounced. The
intensity and pattern of the discoloration may even vary among different sites
in the colon of a single person. The condition may also be reversed upon
discontinuation of laxative use. In some cases, the wall of the colon appears
normal to the eye, but microscopic evaluation of biopsies by a pathologist reveals areas of pigment in
the colon's lining. The pigment in melanosis coli does not accumulate in polyps
or tumors of the large intestine.
What are the signs and symptoms of melanosis coli?
Melanosis coli does not cause symptoms.
Melanosis Coli Diagnosis
Colonoscopy is a procedure that enables an examiner (usually a gastroenterologist) to evaluate the inside of the colon (large intestine or large bowel). The colonoscope is a four-foot long, flexible tube about the thickness of a finger with a camera and a source of light at its tip. The tip of the colonoscope is inserted into the anus and then is advanced slowly, under visual control, into the rectum and through the colon usually as far as the cecum, which is the first part of the colon. Usually, it also is possible to enter and examine the last few inches of the small intestine (terminal ileum).
What causes melanosis coli?
Melanosis coli usually results from chronic use
of laxatives of the anthranoid group. Some examples of anthranoid laxatives are
(sennosides; Senocot, Senokot EXTRA and others) and rhubarb derivatives. Many of these laxatives have been in use for
hundreds of years. In 1997, the U.S. Food and Drug Administration (FDA) banned
the use of the popular anthranoid laxative
phenolphthalein due to fears that it
might be carcinogenic (cancer-causing). Animal studies had shown that extremely
high doses of phenolphthalein led to tumors in animals, but it has never been
shown to cause cancers in humans.
The anthranoid laxatives pass through the gastrointestinal tract unabsorbed
until they reach the large intestine, where they are changed into their active
forms. The resulting active compounds cause damage to the cells in the lining of
the intestine and leads to apoptosis (a form of
cell death). The damaged (apoptotic) cells appear as darkly pigmented bodies that may be taken up by
scavenger cells known as macrophages. When enough cells have been damaged, the
characteristic pigmentation of the bowel wall develops. The condition can
develop after just a few months of laxative use.
Digestive Disorders: Common Misconceptions
How do doctors diagnose melanosis coli?
Melanosis coli can be observed during endoscopic procedures that examine the large intestine, such as colonoscopy and sigmoidoscopy. Sometimes the diagnosis is made upon microscopic examination of biopsies taken during endoscopic procedures.
What is the prognosis (outcome) of melanosis coli?
If a person stops using anthranoid laxatives, the changes associated with melanosis coli lessen over
time and may disappear.
Early studies suggested that anthranoid laxatives might
have carcinogenic or tumor-promoting activities in humans and that the presence
of melanosis coli might signal an increased risk for the development of
colorectal cancer. However, more recent follow-up studies have failed to show an
association between colon cancer and anthranoid laxative use or between colon
cancer and the
finding of melanosis coli.
Medically Reviewed on 1/22/2021
Medically reviewed by Venkatachala Mohan, MD; American Board of Internal Medicine with subspecialty in Gastroenterology
Shazia Ahmed, and Naresh T. Gunaratnam. "Melanosis Coli." N Engl J Med 349:1349 Oct. 2, 2003.