Pill-induced Esophagitis Research Articles

From pill to pain: Alendronate-induced esophageal injury-A case report and review.

Alendronate is used to treat Paget's bone disease, glucocorticoid-induced osteoporosis, and postmenopausal osteoporosis because it suppresses osteoclast activity to stop bone resorption. We present an exceptional case of esophagitis caused by alendronate. Blood tests and other data were normal when the patient was taken to the hospital, but an endoscopic examination revealed significant esophageal redness, erosion, and ulceration, along with pseudomembrane. The patient was given medicine after receiving a diagnosis of alendronate pill-induced esophagitis based on the pathological findings. This case report is a timely reminder of the importance of thorough pharmacovigilance, patient education, and smart therapeutic decision-making in the context of alendronate use. To properly treat and prevent problems with the esophagus caused by alendronate, additional research is required.

Drug-induced mucosal alterations observed during esophagogastroduodenoscopy.

Several features of drug-induced mucosal alterations have been observed in the upper gastrointestinal tract, i.e., the esophagus, stomach, and duodenum. These include pill-induced esophagitis, desquamative esophagitis, worsening of gastroesophageal reflux, chemotherapy-induced esophagitis, proton pump inhibitor-induced gastric mucosal changes, medication-induced gastric erosions and ulcers, pseudomelanosis of the stomach, olmesartan-related gastric mucosal inflammation, lanthanum deposition in the stomach, zinc acetate hydrate tablet-induced gastric ulcer, immune-related adverse event gastritis, olmesartan-asso-ciated sprue-like enteropathy, pseudomelanosis of the duodenum, and lanthanum deposition in the duodenum. For endoscopists, acquiring accurate knowledge regarding these diverse drug-induced mucosal alterations is crucial not only for the correct diagnosis of these lesions but also for differential diag-nosis of other conditions. This minireview aims to provide essential information on drug-induced mucosal alterations observed on esophagogastroduodenoscopy, along with representative endoscopic images.

S2864 Pill-Induced Esophagitis Secondary to Caffeine Pills

S2864 Pill-Induced Esophagitis Secondary to Caffeine Pills

A Case of Pill-induced Esophagitis.

A Case of Pill-induced Esophagitis.

Clinical and endoscopic features of pill-induced esophagitis

Background: Medication can cause an injury in the esophagus by local and systemic effect, leading to esophagitis. Many such medications have been identified as a cause of pill-induced esophagitis. This study was performed to evaluate the clinical and endoscopic findings of pill-induced esophagitis.Methods: This was retrospective observational study, conducted among patients diagnosed endoscopically with pill-induced esophagitis at Ansh gastroenterology clinic, Ahmedabad, India, from April 2017 to March 2021. The data of these patients were recorded in pre-designed case record form by evaluating their past medical records.Results: Total 90 patients were diagnosed with pill-induced esophagitis. Retrosternal chest pain (68.9%), odynophagia (41.1%), dysphagia (25.6%), and epigastric pain (14.4%) were common clinical findings. The major culprit medications were antibiotics, and NSAIDs (non-steroidal anti-inflammatory drugs). Common esophageal endoscopic findings were ulcer (84.4%), erosion (17.8%), and active ulcer bleeding (12.2%). Kissing ulcers were observed in the majority (46.7%) of cases. The majority of ulcer and erosion were located in middle third of the esophagus. All the patients were recovered within 6 to 10 days after treatment with PPIs (proton pump inhibitors) and/or antacids, and withdrawal of the causative medication.Conclusions: Pill-induced esophagitis commonly manifests as retrosternal chest pain, odynophagia and dysphagia, and endoscopy reveals kissing ulcer and erosion in the majority of cases. The condition can be treated with PPIs and/or antacids, and withdrawal of the offending medication.

69-Year Old Man With Dysphagia and Nasal Regurgitation

69-Year Old Man With Dysphagia and Nasal Regurgitation

S3192 Doxycycline: An Unlikely Culprit for Gastric Mucosal Injury

Introduction: Tetracyclines, such as doxycycline, are well-described in literature as a culprit for pill-induced esophagitis. Although rare, there may be a connection to gastric mucosal injury. Given the ubiquitous use of doxycycline, it is worthwhile to investigate the association. Case Description/Methods: A 61 year-old man presented with syncope, melena and acute anemia. Esophagogastroduodenoscopy (EGD) showed erosions and two clean-based ulcers (5 mm and 8 mm) in the antrum (Figure 1A and 1B). Retroflexed view of the incisura revealed fibrinous deposition on the cardia and fundus that was unable to be washed off despite irrigation and suctioning (Figure 1C). Biopsies demonstrated idiosyncratic features consistent with doxycycline-induced injury, with reactive erosions and superficial fibrinoid vascular degeneration. The patient had been taking doxycycline 100 mg daily for three years for chronic dermatomyositis. He was started on pantoprazole twice daily to facilitate mucosal healing and an alternative agent in place of doxycycline was recommended. Follow-up EGD ten weeks later showed normal gastric mucosa without evidence of prior injury. Biopsies were not obtained given healed appearance of the tissue (Figure 1D). Discussion: While doxycycline is widely recognized as an etiology of pill esophagitis, its effect on the gastric mucosa has been highlighted in very few cases. Doxycycline-induced gastric injury is described endoscopically as a superficial, erythematous mucosal erosion with occasional deep ulceration in the antrum or body. It presents with an adherent, light-colored and fibrinous plaque. Histologically, there are reactive changes in the foveolar cells with mucin loss and serrated gastric pits. There is also a distinct pattern of superficial eosinophilic capillary vascular degeneration, which is associated with superficial mucosal necrosis and scattered fibrinous microthrombi (Figure 1E). Clinically, patients present with nonspecific symptoms of epigastric pain or substernal burning. If history reveals doxycycline use, an EGD can be helpful. In most cases, once the offending agent is removed, the symptoms do resolve. It is unclear why only a small subset with doxycycline ingestion develops gastric injury, although we postulate that the incidence is likely under-recognized. It remains unknown how long-term or repeated usage affects the gastric mucosa, as patients on this medication do not routinely undergo endoscopic evaluation in the absence of overt upper gastrointestinal symptoms.Figure 1.: Endoscopic images showing diffuse necrosis of stomach.

Diagnostic Utility of Esophageal Brushing Cytology in Pill-Induced Esophagitis

Diagnostic Utility of Esophageal Brushing Cytology in Pill-Induced Esophagitis

Dysphagia, reflux and related sequelae due to altered physiology in scleroderma.

Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical manifestation of systemic sclerosis and is strongly related to esophageal dysmotility. However, there are multiple other contributing factors in each step in the physiology of swallowing that may contribute to development of severe dysphagia. The oral phase of swallowing may be disrupted by poor mastication due to microstomia and poor dentition, as well as by xerostomia. In the pharyngeal phase of swallowing, pharyngeal muscle weakness due to concurrent myositis or cricopharyngeal muscle tightening due to acid reflux can cause disturbance. The esophageal phase of swallowing is most commonly disturbed by decreased peristalsis and esophageal dysmotility. However, it can also be affected by obstruction from chronic reflux changes, pill-induced esophagitis, or Candida esophagitis. Other contributing factors to dysphagia include difficulties in food preparation and gastroparesis. Understanding the anatomy and physiology of swallowing and evaluating systemic sclerosis patients presenting with dysphagia for disturbances in each step can allow for development of better treatment plans to improve dysphagia and overall quality of life.

Esophageal Disorders

Typically, symptoms that may indicate the presence of an esophageal disorder include heartburn, dysphagia, odynophagia, and regurgitation. Endoscopy is the technique of choice to evaluate the mucosa of the esophagus and to detect structural abnormalities, whereas esophageal manometry is the standard test to diagnose motor disorders of the esophageal body and the lower esophageal sphincter. This review examines normal esophageal anatomy and physiology, the diagnosis of esophageal disorders, disease states causing dysphagia, and gastroesophageal reflux disease. Figures show the cross-sectional anatomy of the esophagus; an algorithm for the evaluation of dysphagia; the anatomy of the gastroesophageal junction; esophagograms of patients with achalasia, late-stage achalasia, and diffuse esophageal spasm; endoscopic views of esophageal strictures; a proximal esophageal web on barium swallow in a patient with Plummer-Vinson syndrome; an endoscopic view of the esophagus of a 25-year-old man with a 3-year history of severe dysphagia; photographs of midesophageal traction diverticulum, multiple epiphrenic diverticula, long-segment Barrett esophagus, and severe Candida esophagitis; and a treatment algorithm for extraesophageal manifestations of gastroesophageal reflux disease. Tables list the high-resolution manometry classification of esophageal motility disorders, causes of esophageal strictures, classic endoscopic findings in patients with eosinophilic esophagitis, the Los Angeles classification of erosive esophagitis, categories of dysplasia, surveillance of Barrett metaplasia, medications implicated in pill-induced esophagitis, and classification of caustic esophageal injury. This review contains 13 figures, 40 tables, and 82 references. Keywords: achalasia, dysphagia, esophagus, reflux, strictures, diverticula, endoscopy, larynx

Pill-induced esophagitis caused by ingesting excessive caffeine tablets

A 19-year-old woman with suicidal thoughts consumed 24 anhydrous caffeine tablets and was admitted to our hospital. After being discharged from the hospital, her oral intake remained impaired because of retrosternal pain and she was readmitted. An upper gastrointestinal endoscopy revealed diffuse ulcers throughout the mid-to-lower esophagus; the patient was diagnosed with caffeine-induced esophagitis. She recovered soon after conservative treatment. A follow-up endoscopy performed 1 month after the patient was discharged showed that the ulcers had healed. This case highlights the risk of esophageal injuries after ingesting excessive caffeine tablets, which were sold as dietary supplement without a prescription. Our experience indicates that endoscopic surveillance is advisable to prevent severe complications if a patient presents with esophageal symptoms suggestive of chemical esophagitis.

1773 Esophageal Obstruction From a “Cough Pill”: Case Report

INTRODUCTION: Foreign body obstruction in the elderly is usually due to an identifiable underlying cause such as psychiatric disease, substance-intoxification, secondary gain, or accidental food related event. Most esophageal obstructions are asymptomatic and usually result in the passage of the foreign body. However, some patients may present with acute onset dysphagia, choking, hypersalivation, blood-tinged saliva, regurgitation, and wheezing. Rarely, foreign body impaction occurs as a complication of pill ingestion. In the cases where a foreign body has been identified in the esophagus endoscopic intervention is indicated in only one out of five cases. This is a rare case of esophageal obstruction due to pill ingestion that resulted in endoscopic intervention. CASE DESCRIPTION/METHODS: Patient is an 80 year old male with a medical history of HTN, atrial fib/flutter, and history of throat cancer in 2003 s/p chemo and radiation who presented to the ED after he felt a "tablet stuck in his throat". He is unable to swallow saliva, with frequent spitting of blood. He had intermittent difficulty swallowing solid food prior to admission. Patient had an esophagram done previously in 2013 which showed slight narrowing of the esophagus at C7 (Figures 1.1 and 1.2). EGD was done which revealed a whitish foreign body in the upper esophagus which was subsequently removed (Figure 1.3), and patient was then able to swallow. DISCUSSION: Pill-induced esophageal obstruction is a rare but serious cause of obstruction. Patients presenting similarly to this case with dysphagia, hypersalivation, blood-tinged salvia, and regurgitation should have thorough history taken to elicit any previous pill ingestion. Prolonged time to diagnosis will lead to delayed intervention, and increased risk of pill-induced esophagitis. Women and elderly are at an increased risk due to higher medicine usage, and decreased saliva production and motility in the elderly. Additionally, radiation therapy to the head and neck greatly impacts swallowing, and is exacerbated by chemotherapy. In cases with elderly patients small pills and liquid formula should be considered to prevent pill impaction. The prolonged transit or stasis of a pill increases the interaction between the pill and the esophageal mucosa causing esophagitis. Pill induced esophagitis will produce ulcers, and presents with dysphagia, difficult swallowing, and odynophagia. sIncreased ability to recognize these patients will lead to more expedient intervention and reduce risks for complications.

Pill-Induced Esophagitis From Intake of Dietary Supplements

ABSTRACTCases of pill-induced esophagitis can be associated with significant acute symptoms leading to hospitalization and have resulted in mediastinal penetration and hemorrhage. Clinicians often consider the diagnosis in patients taking classically associated medications. However, because many patients take dietary supplements, it is important to consider these as a potential etiology in a patient presenting with esophageal symptoms. We present a case of pill-induced esophagitis in a 40-year-old woman after the ingestion of l-arginine, selenium, and vitamin E supplements. Literature review revealed 6 cases of l-arginine–induced esophagitis reported, and no previous cases associated with vitamin E or selenium.

Dysphagia Lusoria in a Patient With Down Syndrome

Introduction: Dysphagia lusoria is a rare cause of dysphagia in which a vascular anomaly causes extrinsic compression of the esophagus. A number of vascular abnormalities can cause dysphagia lusoria, the most common is an aberrant right subclavian artery. Case Report: A 23-year-old man with Down's syndrome presented to clinic with cough, hoarseness and dysphagia. His symptoms were previously thought to be due to asthma with allergic rhinitis, postnasal drip and chronic sinusitis. Thusly he was treated with multiple courses of antibiotics with only partial symptoms relief. Otolaryngology then offered tonsillectomy with septoplasty for a deviated septum. This was declined by the patient's guardian and his symptoms progressed so he was referred to gastroenterology. Initial evaluation was done with barium esophagogram and upper endoscopy (EGD). Barium esophagogram showed normal emptying and a small filling defect near the gastroesophageal junction. The EGD revealed an esophageal ulcer at the gastroesophageal junction and a dilated esophagus (Fig 1). Biopsy of the ulcer showed acute and chronic inflammation. The patient was on doxycycline for acne vulgaris and folliculitis so the initial concern was for pill-induced esophagitis. A proton-pump inhibitor was initiated and recommendations were made to avoid tetracyclines. Despite these interventions his symptoms did not improve so esophageal manometry was undertaken. Manometry showed distal esophageal spasm and simultaneous swallows with poor bolus transit (Fig 2). Based on his manometric results and his history of Down's syndrome the diagnosis of dysphagia lusoria was considered. Computed tomography (CT) revealed an aberrant right subclavian artery exerting a mass effect on the posterior esophagus (Fig 3). Vascular surgery was consulted but the patient's guardian has deferred surgery at this time and plans to monitor his symptoms.FigureFigureFigureDiscussion: Dysphagia lusoria is a rare vascular anomaly resulting in extrinsic compression of the esophagus. Barium esophagogram classically shows an oblique filling defect coursing from the left inferior to right superior esophagus. Definitive diagnosis can be made by endoscopic ultrasonography or CT imaging. An aberrant subclavian artery is most often asymptomatic throughout life. For symptomatic patients the initial management should be through dietary and lifestyle modifications. For intractable symptoms surgical intervention should be considered.

Pill-Induced Esophagitis with Mucosal Dissection: A Case Report

Pill-induced esophageal injury was first described in 1970. It occurs when a caustic medicinal pill dissolves in the esophagus and releases its noxious content, particularly if transit is delayed. Injury of this type, called pill esophagitis or pill induced esophageal injury is common but unfortunately is under-reported. More than a hundred different medicines have been reported to cause esophageal injury.

Diseases of the Stomach

There are multiple diseases of the stomach and esophagus that will lead a patient to seek emergent care, including peptic ulcer disease (PUD), esophagitis, dysphagia, esophageal foreign bodies, and gastroesophageal reflux disease (GERD). Hemorrhage and perforation are major emergencies in peptic ulcer disease and esophageal disease requiring early recognition with immediate resuscitative efforts to stabilize. This review covers the risk factors, pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for patients with diseases of the stomach and esophagus. Figures show illustrations of esophageal anatomy, an algorithm for the evaluation of dysphagia, the pathogenesis of peptic ulcers, and radiographs demonstrating an esophageal button battery and pneumoperitoneum caused by a perforated ulcer. Tables list some common causes of esophageal stricture and pill-induced esophagitis, differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate Helicobacter pylori infection. Key Words: Peptic ulcer disease, esophagitis, dysphagia, esophageal foreign body, GERD, H. Pylori, button battery

Diseases of the Stomach

There are multiple diseases of the stomach and esophagus that will lead a patient to seek emergent care, including peptic ulcer disease (PUD), esophagitis, dysphagia, esophageal foreign bodies, and gastroesophageal reflux disease (GERD). Hemorrhage and perforation are major emergencies in peptic ulcer disease and esophageal disease requiring early recognition with immediate resuscitative efforts to stabilize. This review covers the risk factors, pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for patients with diseases of the stomach and esophagus. Figures show illustrations of esophageal anatomy, an algorithm for the evaluation of dysphagia, the pathogenesis of peptic ulcers, and radiographs demonstrating an esophageal button battery and pneumoperitoneum caused by a perforated ulcer. Tables list some common causes of esophageal stricture and pill-induced esophagitis, differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate Helicobacter pylori infection. Key Words: Peptic ulcer disease, esophagitis, dysphagia, esophageal foreign body, GERD, H. Pylori, button battery

Histomorphological and immunophenotypic features of pill-induced esophagitis

Histomorphological and immunophenotypic features of pill-induced esophagitis

Pill -Induced Erosive Esophagitis in Children.

AimsPill-induced esophagitis has been recognized in adults, but rarely in children. The aim of this article is to discuss endoscopic features, drugs implicated, prevention and treatment in pill-induced esophagitis in children.Patients and methodsOver a period of 4 years, 26 patients presented at our clinic with drug-induced esophageal ulcerations. All patients were diagnosed by means of endoscopy and treated with proton-pump inhibitors and prokinetics. The mean age of the children was 10.76 years.ResultsThe ulcers were frequently located at the mid-esophagus. Odynophagea, retrosternal pain and dysphagia were the most common presenting symptoms. All children took pills (non-steroidal anti-inflammatory drugs, antibiotics – Doxycycline and ferrous sulfate) with little water and at bed time. The mean elapse between the drug intake and endoscopy was 4.96 days. The symptoms resolved within a maximum of one week of antireflux therapy.ConclusionsIn pediatric cases treated by tablets or capsules, the possibility of medication-induced esophagitis should always be considered. The drug-induced esophagitis should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough water and in the upright position.

Refractory gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD. In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions. The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis.