Pill-induced Esophagitis Research Articles

An Uncommon Cause of Dysphagia

A 65-year-old woman presented to a north Indian tertiarycare center with progressive dysphagia, loss of appetite, and loss of weight (12 kg) over 3 months. There was no history of odynophagia, fever, intake of caustic agent, or intake of any medication known to cause pill-induced esophagitis. She was a nonsmoker and a tee-totaller. There was no significant past history or any comorbid illness. There was no family history of malignancy. On examination she had a BMI of 19.4 kg/m with no palpable lymphadenopathy or organomegaly. Her investigations showed normal renal and liver function tests. Her hemoglobin was 12.2 g% with an ESR of 46 mm/h. Her chest radiograph was normal and HIV serology was negative. She underwent an esophagogastroduodenoscopy which showed a punched-out ulcer with elevated edges at 26 cm from incisors (Fig. 1). Multiple biopsies taken from the ulcer and its edges were evaluated histologically (Fig. 2). She subsequently underwent a computed tomography of the chest (Fig. 3) and endoscopic ultrasound (Fig. 4). Questions

Drug-induced esophageal injury with an occult vascular ring

Drug-induced esophageal injury is an under-recognized clinical problem, and is associated with antibiotic use in more than 50% of cases. The current report describes a teenage girl who presented with symptoms of pill-induced esophagitis following doxycycline use. Subsequent investigations identified a previously undiagnosed vascular ring. Although most patients who experience drug-induced esophageal injury have no underlying anatomical or functional disorder of the esophagus, the condition is more common in areas of esophageal narrowing. The present case illustrates the possibility of an occult esophageal obstruction representing a risk factor for pill esophagitis. The etiologies, mechanisms and management of drug-induced esophageal injury are reviewed, and aspects of vascular rings that are relevant to paediatricians are discussed.

Antiretroviral therapy alone resulted in successful resolution of large idiopathic esophageal ulcers in a patient with acute retroviral syndrome

Antiretroviral therapy alone resulted in successful resolution of large idiopathic esophageal ulcers in a patient with acute retroviral syndrome

52-Year-Old Woman With Dysphagia

52-Year-Old Woman With Dysphagia

Drug-lnduced Esophagitis in a Tertiary Care Hospital

Drug induced esophagitis, also known as pill-induced esophagitis or drug-induced esophageal injury, is uncommonly encountered in clinical practice. This observational study was jointly carried out by the Department of Medicine and Department of Gastroenterology, Rajshahi Medical College, from January 2005 to December 2009. Total number of patients included was 32. Patients who presented with history of odynophagia and chest pain after ingesting some medications and having endoscopic evidence of esophagitis were included in this study. Out of 32 patients 17 were female and 15 were male (F: M=1.1:1). Mean age of the patients were 36.7±8.5 years. Doxycycline was the drug most commonly associated with esophagitis, 25 cases (78.1%) had doxycycline induced esophagitis. Other drugs were tetracycline in 3 cases (9.4%), alendronate in 1 case (3.1%), ciprofloxacin in 1 case (3.1%), paracetamol in 1 case (3.1%), and naproxen in 1 case (3.1%), Increased awareness among the physicians and patient education can prevent this distressing clinical condition.TAJ 2009; 22(1): 235-238

Clinically Silent Right-Sided Aortic Arch Unmasked by Pill-Induced Esophagitis

Clinically Silent Right-Sided Aortic Arch Unmasked by Pill-Induced Esophagitis

Refractory GERD: What is it?

Refractory gastroesophageal reflux disease (GERD) is very common and may affect up to 40% of patients who use a proton pump inhibitor (PPI) once daily. Refractory GERD can present as incomplete or lack of response to PPI therapy. The disorder is clearly driven by patients, who present with a wide range of symptom severity and frequency while on PPI treatment. Poor compliance and improper timing of PPI consumption should always be excluded before further evaluation of this patient population. The putative mechanisms for refractory GERD include weakly acidic reflux, duodenogastroesophageal/bile reflux, visceral hypersensitivity, delayed gastric emptying, psychological comorbidity, and concomitant functional bowel disorders. Reduced PPI bioavailability, rapid PPI metabolism, PPI resistance, nocturnal reflux, and Helicobacter pylori infection status have very limited roles in refractory GERD. The contribution of eosinophilic esophagitis to refractory GERD is still unknown. Pill-induced esophagitis, Zollinger-Ellison syndrome, achalasia, and other disorders are rarely responsible for PPI failure and usually are not confused with GERD.

An Unsual Case of Severe Pill Esophagitis Mimicking Herpetic Esophagitis, Caused by a New OTC NSAID – Containing Sleeping Aid

We present a case of severe NSAID induced esophagitis, mimicking severe herpetic esophagitis, caused by a new sleeping aid OTC preparation that combines naproxen and diphenhydramine. This type of preparation caused severe injury to the esophagus, its use as a bedtime sleeping aid, greatly increasing the risk of pill induced esophagitis. We could find no product labeling warning patients of this potential complication. This 37 yo man with a hx of dyspepsia, IBS, and chronic insomnia, developed acute severe odynophagia, which did not respond to PPI's, or antacids, only able to swallow small amounts of liquids. He repeatedly denied taking any pills associated with pill induced esophagitis. Urgent EGD revealed very severe discontinuous ulcerations with almost complete slough of the distal esophageal mucosa, suggestive of severe herpetic esophagitis. Biopsies and viral cultures were negative for herpes. Patient improved with the addition of liquid sucralfate qid. On subsequent questioning he remembered taking a naproxen containing sleeping aid (Advil-PM®) at bedtime with little water for several days prior to the symptoms. The preparation was stopped, syptoms resolved, and repeat endoscopy showed healing of the ulcerated esophageal mucosa. Many patients take sleeping aids for insomnia, that typically have acetominephen and diphenhydramine, such as Tylenol PM®. We were suprised to learn of the existence of a similar OTC NSAID preparation (Advil PM®). In our previous case-controlled study (Gastrointest Endoscopy 2004; 59:AB240) NSAID's were the most common cause of pill induced esophagitis. A preparation that combines an NSAID with a sleeping aid, carries particular risk for inducing pill-induced esophagitis, due to its bed-time use. Patients need to be cautioned about this potential side effect of this type of preparation. The injury was particularly severe, but responded to NSAID cessation, and PPI and sucralfate therapy. Clinicians need to be aware of new sleeping aid OTC preparations that contain NSAID's, caution patients about their potential for inducing pill esophagitis, and question patients with unexplained esophageal ulcerations and odynophagia about their use.

Pill‐induced esophagitis within esophageal diverticulae

Journal of Gastroenterology and HepatologyVolume 22, Issue 2 p. 287-287 Pill-induced esophagitis within esophageal diverticulae Charles Berkelhammer, Charles Berkelhammer Christ Hospital, University of Illinois, Oak Lawn, Illinois, USASearch for more papers by this authorPadmaja Gutti, Padmaja Gutti Christ Hospital, University of Illinois, Oak Lawn, Illinois, USASearch for more papers by this author Charles Berkelhammer, Charles Berkelhammer Christ Hospital, University of Illinois, Oak Lawn, Illinois, USASearch for more papers by this authorPadmaja Gutti, Padmaja Gutti Christ Hospital, University of Illinois, Oak Lawn, Illinois, USASearch for more papers by this author First published: 29 January 2007 https://doi.org/10.1111/j.1440-1746.2006.04472.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume22, Issue2February 2007Pages 287-287 RelatedInformation

Aging, the gastrointestinal tract, and risk of acid-related disease

It is estimated that by 2020, >16% of people in the United States will be ≥65 years of age and that nearly 20 million will be >85 years of age. Aging imparts a variety of physiologic changes in the oropharynx, esophagus, and stomach that increase the risk for esophageal and gastrointestinal disorders. Older individuals also tend to have a higher prevalence of comorbid factors, such as Helicobacter pylori infection, smoking, presence of other diseases, or use of medications (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]) that increase their risk for acid-related disorders. Given these physiologic and comorbidity factors, the elderly are at higher risk for gastroesophageal reflux disease (GERD), pill-induced esophagitis, peptic ulcer disease, and complications related to the use of NSAIDs. Unfortunately, in the elderly patient with these disorders—even those with severe disease or complications—symptom presentation may be subtle or atypical, resulting in a delayed diagnosis. Endoscopy remains the “gold standard” for the identification of mucosal disease and should be performed in all patients with “new-onset” or persistent symptoms who are >45 years of age, as well as in individuals of any age who present with alarm symptoms, such as weight loss, vomiting, anemia, dysphagia, or evidence of gastrointestinal bleeding. In general, the treatment of older individuals with peptic ulcer or GERD and its complications is similar to that of younger individuals. Proton pump inhibitors are the mainstay of therapy for symptom relief, healing of erosive esophagitis, resolution of peptic ulceration, reduction of the risk for NSAID-induced mucosal damage, and prevention of disease recurrence.

Complications œsophagiennes des médicaments anti-inflammatoires non stéroïdiens

The effect of non steroidal anti-inflammatory drugs (NSAIDs) on esophageal mucosa is not well known. NSAIDs do not provoke gastro-esophageal reflux disease in healthy subjects but can worsen a preexistant non symptomatic reflux. Mechanism of action is not determined; NSAIDs do not modify the motility of lower esophagus sphincter or of esophageal body. A significant increase of symptoms of GERD (hearthburn and acid regurgitation) is observed in patients treated with NSAIDs. Relative risk of GERD symptoms with NSAIDs is about 2. Erosive esophagitis is common in elderly patients taking NSAIDs but it is not proven that an increased risk of esophagitis exists with NSAID therapy. Case-control studies favored an association between NSAIDs consumption and benign esophageal stricture. NSAIDs can provoke a pill-induced esophagitis, specially if the drugs are absorbed without water and in case of preexistant acid reflux.

Pill-induced esophagitis complicated by multiple esophageal septa

Pill-induced esophagitis is a well-recognized cause of dysphagia and odynophagia. Various medications are known to cause pill esophagitis, but potassium chloride is the prototype. Increasing numbers of patients are being treated with diuretic agents, and, as a result, potassium replacement is extremely common in clinical practice. The exact incidence of pill-induced esophagitis is unknown.

Pill-induced esophagitis within esophageal diverticula

Pill-induced esophagitis within esophageal diverticula

Pill-induced esophagitis

Pill-induced esophagitis

Pill-induced esophagitis caused by lansoprazole

Pill-induced esophagitis caused by lansoprazole

Lozenge-induced esophagitis

Pill-induced esophagitis is uncommon but may result in considerable morbidity because of the severity of the injury. Most patients do not have a detectable esophageal disorder; rather, the chemical injury is related to the manner in which the culprit pill is ingested. The list of incriminated drugs is long and the range of injury spans mild inflammatory changes to severe ulceration and stricture formation. This report describes the occurrence of esophagitis after the preoperative ingestion of a Mentho-Lyptus lozenge (Halls, Warner Lambert Co., Morris Plains, N.J.).

Thermal injury from a hamburger: a rare cause of odynophagia

The common causes of odynophagia include pillinduced esophagitis, caustic injury (acid or alkali), infectious esophagitis (mainly viral or candidiasis in immunocompromised patients), severe reflux esophagitis and, rarely, esophageal tumors.1 Thermal injury is not mentioned among the causes of odynophagia. We describe a young man who developed odynophagia and an esophageal ulcer after swallowing a bite of an extremely hot hamburger and review the few available reports regarding thermal injury and the esophagus.

A Case of Pill‐Induced Esophagitis With Mucosal Dissection

With the advance of gastrointestinal endoscopy, pill-induced esophagitis has been detected more frequently, but the association of mucosal dissection is rare. We reported a case of pill-induced esophagitis associated with mucosal dissection. A 66-year-old male with combined valvular heart disease was admitted for cardiac surgery. Cefotiam hydrochloride tablet was administered for postoperative wound infection of cardiac surgery. Next morning severe odynophagia and retrosternal pain were occurred. Upper gastrointestinal endoscopy performed 2 days after onset of the symptom showed detached mucosa at the upper thoracic esophagus and acute esophagitis at middle and lower thoracic esophagus. Histological examination of the mucosa revealed that the esophageal mucosa was detached from the lamina propria. After the treatment for esophagitis, almost normal esophageal mucosa covered the esophagus without scarring or stricture. The present case was diagnosed as cefotiam hydrochloride tablet induced esophagitis because of the onset of this disease. Mucosal dissection of the esophagus may be associated with both the esophagitis and bleeding tendencies caused by anticoagulant therapy.

An unusual presentation of pill-induced esophagitis

An unusual presentation of pill-induced esophagitis

Aspirin-Induced Esophageal Hemorrhage

To the Editor. —Pill-induced esophagitis has been recognized with increasing frequency since it was first described in 1970. 1,2 It most commonly occurs in association with the use of doxycycline, tetracycline, quinidine, emepromium bromide, or potassium chloride. 3 Surprisingly, aspirin therapy rarely causes pill-induced esophagitis and has not been known to induce significant bleeding. We describe a case of aspirin-induced esophageal injury that presented with hematemesis and an esophageal mass. Report of a Case. —A 52-year-old man with a history of peptic ulcer disease and a cerebral vascular accident that resulted in paralysis developed nausea, vomiting without hematemesis, and syncope. The medications he received were aspirin, two tablets twice a day, haloperidol, benztropine mesylate, and clonidine. In the emergency department, he vomited about 1 L of blood and was hypotensive. After stabilization, he underwent esophagogastroduodenoscopy. Profuse bleeding originated from the lower part of the esophagus. The exact site of hemorrhage