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Coseru AI, Ciortescu I, Nemteanu R, Barboi OB, Floria DE, Vulpoi RA, Strungariu DG, Ilie SI, Rosca V, Drug VL, Plesa A. Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review. Diseases 2024; 12:263. [PMID: 39452506 PMCID: PMC11506947 DOI: 10.3390/diseases12100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 09/29/2024] [Accepted: 10/19/2024] [Indexed: 10/26/2024] Open
Abstract
Novel direct oral anticoagulants (DOACs) are prescribed worldwide in the treatment of non-valvular atrial fibrillation. Adverse reactions have been reported following the use of DOACs. One notable trend in the literature is the growing number of reported cases of esophagitis dissecans superficialis (EDS) generated by DOAC use. We hereby report the case of a 73-year-old woman who presented to the hospital with asthenia, dysphagia, and melena two days prior to admission. The patient had taken apixaban due to non-valvular paroxysmal atrial fibrillation for a few weeks. The biological panel showed moderate anemia with a hemoglobin level of 7.7 g/dL Apixaban-induced EDS was diagnosed by the characteristic endoscopic findings. The patient received treatment with a proton pump inhibitor (pantoprazole) in a double dose. Also, an iron treatment was recommended for a period of six months. The follow-up endoscopy at one month confirmed the healing of the esophageal lesions. The case was discussed with the cardiologist. The first anticoagulant treatment proposed after discharge was a vitamin K antagonist (acenocumarol) but the patient refused this medication and thus it was decided to initiate rivaroxaban. Although DOACs have demonstrated their efficacy in the prevention and treatment of stroke and thromboembolism among the aging demographic, cases of DOAC-induced EDS will continue to pose numerous challenges for physicians worldwide.
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Affiliation(s)
- Alexandru Ionut Coseru
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
| | - Irina Ciortescu
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Roxana Nemteanu
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Oana-Bogdana Barboi
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Diana-Elena Floria
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Radu-Alexandru Vulpoi
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Diana Georgiana Strungariu
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
| | - Sorina Iuliana Ilie
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
| | - Vadim Rosca
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Vasile-Liviu Drug
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Alina Plesa
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
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Abdi S, Masbough F, Nazari M, Abbasinazari M. Drug-induced esophagitis and helpful management for healthcare providers. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2022; 15:219-224. [PMID: 36311965 PMCID: PMC9589134 DOI: 10.22037/ghfbb.v15i3.2591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
In recent decades, the number of cases developing drug-induced esophagitis (DIE) has reportedly been growing, which indicates the significance of detecting medicines capable of causing this adverse reaction. This study aims to provide an updated review on recent case reports of DIE, to evaluate the possible mechanism of this side effect, and to provide helpful management. Data was gathered through searches of three databases, namely PubMed, Medline, and Cochrane. Seven drug categories were evaluated: antibiotics, bisphosphonates, cardiovascular medicines, chemotherapeutic agents, non-steroidal anti-inflammatory drugs (NSAIDs), other medications, and supplements. According to the findings, retrosternal pain, heartburn, odynophagia, and dysphagia are typical symptoms of DIE, and in most cases, DIE is a self-limiting side effect which can be resolved by removing the causative agent and providing supportive therapy.
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Affiliation(s)
- Saeed Abdi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnoosh Masbough
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nazari
- Department of Pharmaceutical Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abbasinazari
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sudo G, Goto A, Fujisawa T, Nakase H. Haemorrhagic exfoliative oesophagitis associated with nasogastric tube placement. BMJ Case Rep 2020; 13:13/11/e237485. [PMID: 33229484 DOI: 10.1136/bcr-2020-237485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 92-year-old man hospitalised for cerebral infarction developed haematemesis. The patient was taking low-dose aspirin and apixaban for his cerebral infarction and non-valvular atrial fibrillation. His enteral nutrition was administrated through nasogastric tube. Upper endoscopy revealed active bleeding from a protruded lesion in the upper oesophagus. The lesion was removed by washing with a water jet, followed by successful endoscopic haemostasis. Histopathological examination revealed degenerated squamous epithelium without specific findings; the diagnosis was exfoliative oesophagitis. In our case, mechanical mucosal injury caused by nasogastric tube placement may result in exfoliative oesophagitis. In addition, the use of low-dose aspirin with apixaban may have contributed to the bleeding. We then performed a wire-guided nasogastric tube placement under fluoroscopy. No further bleeding was observed, but the patient died of sepsis 1 month later. This case highlights the importance of a risk assessment and management of oesophageal complications associated with nasogastric tube placement.
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Affiliation(s)
- Gota Sudo
- Department of Gastroenterology and Hepatology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.,Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Akira Goto
- Department of Gastroenterology and Hepatology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takashi Fujisawa
- Department of Pathology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Yang ZQ, Mai JY, Zhu ML, Xiao XM, He XX, Chen SQ, Lin ZL. Clinical analysis of a case of neonatal exfoliative esophagitis in an 18-day-old neonate. BMC Pediatr 2019; 19:464. [PMID: 31775688 PMCID: PMC6882000 DOI: 10.1186/s12887-019-1839-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to provide guidance for clinical work through analysis of the clinical characteristics, endoscopic and pathological manifestations, diagnosis, and treatment of an 18-day-old neonate with exfoliative esophagitis. CASE PRESENTATION The patient presented with vomiting but the parents did not pay too much attention. The pathological report revealed numerous fibrinous exudative necrotic, and inflammatory cells, as well as a small amount of squamous epithelium. Furthermore, milk allergy factors were considered. Conservative treatments, such as fasting, acid suppression, mucosal protection, parenteral nutrition, and the replacement of anti-allergic milk powder were given. Thereafter, endoscopic examination revealed that the patient returned to normal, and was discharged after 21 days. CONCLUSIONS Exfoliative esophagitis has multiple causes; and has characteristic clinical and endoscopic manifestations. Endoscopic examination after 18 days presentation and conservative therapy revealed that the esophagus had returned to a normal appearance and the patient was discharged. Following discharge, the parents were advised to feed the patient ALFERE powder. Attention should be given to the timely detection of complications and corresponding treatment.
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Affiliation(s)
- Zu-Qin Yang
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China
| | - Jing-Yun Mai
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China.
| | - Min-Li Zhu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China
| | - Xiu-Man Xiao
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China
| | - Xiao-Xiao He
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China
| | - Shang-Qin Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China
| | - Zhen-Lang Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 of Xue yuan west Street, Lucheng District, Wenzhou, 325027, China
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