PREreview of Gastrointestinal Complications of Cocaine Use: A Comprehensive Literature Review

Major issues

• This narrative review synthesizes current evidence on the gastrointestinal complications associated with cocaine use, highlighting how vasoconstriction, microvascular dysfunction, thrombosis, and direct mucosal toxicity contribute to a wide spectrum of injury. The authors summarize pharmacokinetics, pharmacodynamics, and routes of administration, then connect these mechanisms to clinical presentations ranging from ischemic colitis and mesenteric infarction to ulceration, perforation, hepatobiliary injury, and rare complications such as intussusception. By consolidating scattered case reports and small studies into a coherent clinical framework, the review advances the field by clarifying the breadth of cocaine‑related GI pathology and emphasizing the need for heightened clinical suspicion in young patients presenting with abdominal pain or ischemic features.

Minor issues

• The flow of the results section would benefit from clearer transitions between categories of complications and more consistent depth across subsections. A summary table that outlines mechanisms, typical presentations, and associated outcomes would improve readability and clinical usefulness. Some terminology could be standardized, particularly when distinguishing ischemic, inflammatory, and ulcerative processes. Additional context on diagnostic challenges, such as overlap with inflammatory bowel disease or infectious colitis, would strengthen the clinical framing. Minor editorial refinements, including reducing repetition and tightening sentence structure in a few areas, would improve clarity without changing the overall conclusions.

Competing interests

The author declares that they have no competing interests.

Use of Artificial Intelligence (AI)

The author declares that they did not use generative AI to come up with new ideas for their review.