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At the same time, this process will influence the function of intestinal immunity and will lead to the deposition of pigment on the mucosa.31 The long-term use of laxatives can cause epithelial cell damage, and the disruption of mucosal integrity triggers the release of immune competent cells, such as mast cell, in turn leading to the deposition of pigment on the mucosa.32 Direct toxic effects of drugs on epithelial cells are involved in the pathogenesis of MC It has been concluded that anthraquinone laxatives would have direct toxic effects on colonic epithelial cells, which tend to produce lipofuscin, engulfed by nearby macrophages and then generate brown or black pigments.3 It has been suggested that anthraquinone laxatives produce toxic substances in the large intestine, where they damage epithelial cells.31 These substances alter the functions of normal cellular absorption, secretion and proliferation by inducing apoptosis, reducing the number of mucosal crypts and increasing cell proliferation

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