Dabigatran-Induced Esophagitis

Abstract

We report 2 cases of drug-induced esophagitis associated with dabigatran, a new oral anticoagulant. Both patients were prescribed dabigatran at 110 mg twice daily for atrial fibrillation as an alternative to warfarin. The first case was a 70-year-old man who had been taking dabigatran for 14 days and was referred to our hospital because of retrosternal pain and dysphagia. He experienced symptom onset immediately after taking dabigatran the previous evening. Endoscopy showed diffuse “kissing erosions” at the anterior and the posterior wall of the broncho-aortic constriction in the midesophagus (Figure A). Gentle water lavage through the biopsy port caused a linear tear at the lesion (Figure B). Dabigatran was discontinued, and rabeprazole was administered, resulting in significant improvement of symptoms within days. After 5 days, endoscopy revealed disappearance of erosions, with linear ulcer scar at the mid-esophagus (Figure C). The second case was a 73-year-old man who had been taking dabigatran for 5 days and presented with retrosternal pain and odynophagia for 1 day. Endoscopy showed longitudinal sloughing mucosal casts in the middle to distal esophagus, with sparing of the squamocolumnar junction (Figures D–F). After the procedure, dabigatran was immediately discontinued, and rabeprazole was started. The symptoms disappeared within 1 week. Dabigatran, an oral direct thrombin inhibitor, is increasingly prescribed as an alternative to warfarin. An advantage of this agent over warfarin is that it does not require routine laboratory monitoring and dose adjustments and avoids many of the drug and food interactions. It is well-known that dabigatran induces stomach pain