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Richmond M, DeVore EK, Song PC. Esophageal Dysphagia in Adults: When It Sticks. Otolaryngol Clin North Am 2024; 57:569-579. [PMID: 38604886 DOI: 10.1016/j.otc.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Esophageal dysphagia is a common yet difficult to diagnose condition. This article underscores the role of detailed patient history and physical examinations, including prompt endoscopic evaluation, for accurate differentiation between esophageal and oropharyngeal dysphagia. The authors discuss the heightened importance of early intervention in certain patient groups, such as elderly individuals and patients with head and neck cancer, to mitigate the risk of malnutrition and infection. The authors delve into etiologic factors highlighting the complexity of clinical presentations and the significance of tailored management strategies.
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Affiliation(s)
- Miller Richmond
- Georgetown School of Medicine, 3900 Reservoir Road, NW, Washington, DC 20057, USA
| | - Elliana Kirsh DeVore
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Phillip C Song
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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2
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Fan Z, Khizar H, Lu J, Wang A, Xun T, Zhang X, Zhao H. From pill to pain: Alendronate-induced esophageal injury-A case report and review. JGH Open 2024; 8:e13080. [PMID: 38832136 PMCID: PMC11144282 DOI: 10.1002/jgh3.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/14/2024] [Accepted: 04/21/2024] [Indexed: 06/05/2024]
Abstract
Background Alendronate is used to treat Paget's bone disease, glucocorticoid-induced osteoporosis, and postmenopausal osteoporosis because it suppresses osteoclast activity to stop bone resorption. Case report 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. Conclusion 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.
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Affiliation(s)
- Zhen Fan
- Department of GastroenterologyHangzhou First People's HospitalHangzhouChina
| | - Hayat Khizar
- Department of GastroenterologyHangzhou First People's HospitalHangzhouChina
| | - Jinjiao Lu
- The Fourth School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Anhua Wang
- Department of GastroenterologyWenling First People's HospitalTaizhouChina
| | - Tong Xun
- Department of PathologyHangzhou First People's HospitalHangzhouChina
| | - Xiao Zhang
- Department of GastroenterologyHangzhou First People's HospitalHangzhouChina
| | - Hongfeng Zhao
- Department of Infection ControlHangzhou First People's HospitalHangzhouChina
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3
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Thapa S, Yadav GK, Mondal R, Phulware RH. Esophageal Melanocytosis. Autops Case Rep 2024; 14:e2024487. [PMID: 38803486 PMCID: PMC11129856 DOI: 10.4322/acr.2024.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/29/2024] [Indexed: 05/29/2024]
Abstract
Esophageal melanocytosis is a rare entity defined by the proliferation of a melanocytic basal layer of the esophageal squamous lining and deposition of melanin in the esophageal mucosa. Esophageal melanocytosis is considered a benign entity of unknown etiology; however, it has been reported as a melanoma precursor. We report a case of esophageal melanocytosis in a diabetic and hypertensive 67-year-old male with recurrent dizziness and syncope for the past 6 months. Given his complaint of dyspepsia, he underwent an upper gastrointestinal endoscopy, in which an esophageal biopsy revealed the diagnosis of esophageal melanocytosis. The definitive diagnosis of esophageal melanocytosis can only be made by histological analysis. The histologic differential diagnoses include melanocytic nevi and malignant melanoma. Therefore, they need to be ruled out.
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Affiliation(s)
- Samikshya Thapa
- All India Institute of Medical Sciences, Department of Pathology & Laboratory Medicine, Rishikesh, Uttarakhand, India
| | - Gajendra Kumar Yadav
- All India Institute of Medical Sciences, Department of Pathology & Laboratory Medicine, Rishikesh, Uttarakhand, India
| | - Ratna Mondal
- All India Institute of Medical Sciences, Department of Pathology & Laboratory Medicine, Rishikesh, Uttarakhand, India
| | - Ravi Hari Phulware
- All India Institute of Medical Sciences, Department of Pathology & Laboratory Medicine, Rishikesh, Uttarakhand, India
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4
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Iwamuro M, Kawano S, Otsuka M. Drug-induced mucosal alterations observed during esophagogastroduodenoscopy. World J Gastroenterol 2024; 30:2220-2232. [PMID: 38690017 PMCID: PMC11056913 DOI: 10.3748/wjg.v30.i16.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
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.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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5
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Almayoof M, Abbarh S, Mohammed A, Sawaf B, Alawad MJ, Alobaidy M. Esophageal Ulceration Following the Ingestion of a Single Dose of Doxycycline: A Case Report. Cureus 2024; 16:e57043. [PMID: 38681403 PMCID: PMC11048716 DOI: 10.7759/cureus.57043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Doxycycline is one of the medications that cause drug-induced esophagitis. This condition occurs due to prolonged contact of the medications with the esophageal mucosa, leading to erosion, ulcers, and, in some cases, stricture of the esophagus. Chest pain, dysphagia, and odynophagia are the most common symptoms. Endoscopy is the gold standard for confirming the diagnosis. The treatment consists of stopping the offending medication and starting proton pump inhibitors (PPIs) and sucralfate. Herein, we describe a middle-aged man who presented with severe chest pain, odynophagia, and dysphagia that started two hours after ingesting the first doxycycline pill. An endoscopy showed multiple longitudinal ulcers in the distal esophagus. Symptoms significantly improved after starting a PPI and sucralfate, and feeding was resumed two days later. A follow-up with endoscopy after two months reported completely healed esophageal ulcers. In conclusion, doxycycline-induced esophageal injury is often an underdiagnosed and underreported condition. Physicians and patients should be more aware of doxycycline's detrimental effect on the esophagus, as it can induce esophageal ulceration even after a single dose if not administered properly. Therefore, all patients prescribed oral doxycycline should receive appropriate instructions to minimize this side effect.
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Affiliation(s)
| | - Shahem Abbarh
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
- College of Medicine and Surgery, Almaarefa University, Riyadh, SAU
| | | | - Bisher Sawaf
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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6
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Qiu TY, Tan YY, Tee Chin Hock N, R R. An Unusual Presentation of Cobblestone Esophagus From Bisphosphonate Use. Cureus 2024; 16:e52602. [PMID: 38374855 PMCID: PMC10875321 DOI: 10.7759/cureus.52602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Cobblestone esophagus is a rare finding that has been previously described in cases of eosinophilic esophagitis (EoE), candidiasis, Barrett's esophagus, or severe reflux esophagitis from distal gastrointestinal obstruction. We describe a case of asymptomatic cobblestone esophagus secondary to bisphosphonate use. A 67-year-old female was seen in the clinic for evaluation of microcytic anemia that was incidentally picked up on routine chronic disease follow-up. She had no gastrointestinal symptoms. She has been taking oral alendronate 70mg once a week for osteoporosis since a year ago. Barium meal was performed as the patient initially opted for non-invasive testing, which incidentally showed a diffuse "cobblestone" appearance. Subsequent oesophago-gastro-duodenoscopy (OGD) showed diffuse white nodular lesions along the esophagus with a cobblestone appearance but no ulcer or mass. Segmental esophageal biopsies were negative for fungal stain and did not show any pathology. In the absence of infection, eosinophilic esophagitis, and dysplasia, her "cobblestone" esophagus was attributed to bisphosphonate use by diagnosis of exclusion. Alendronate acid was held off, and serial barium meals over the next year showed significant interval improvement. Bisphosphonates, such as alendronate acid, are commonly associated with drug-induced esophagitis. With the cessation of the offending medication, there was indeed a significant improvement in our patient's serial barium meal. It is important to review the medication list when encountering patients who present with cobblestone esophagus, as some of these patients with drug-induced esophagitis may be asymptomatic clinically.
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Affiliation(s)
- Tian Yu Qiu
- Gastroenterology and Hepatology, Singapore General Hospital, Singapore, SGP
| | - Yi Yuan Tan
- Gastroenterology and Hepatology, Singapore General Hospital, Singapore, SGP
| | | | - Rajesh R
- Gastroenterology and Hepatology, Singapore General Hospital, Singapore, SGP
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7
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Caratenuto R, Karanfilian B, Navlani R, Dalal I, Sharma R, Dave P. Social Media Trends, Dry Scooping, and Extensive Esophageal Ulcerations. J Gen Intern Med 2023; 38:3633-3635. [PMID: 37758968 PMCID: PMC10713499 DOI: 10.1007/s11606-023-08432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
We describe a case of severe odynophagia and dysphagia caused by dry scooping of multi-ingredient pre-workout powder (MIPS) with diffuse esophageal ulcerations on upper endoscopy. Dry scooping refers to ingesting work out supplements without the recommended doses of solvent. This trend has been the subject of TikTok and other social media sites aimed at enhancing workout performance. While caustic ingestions leading to esophageal ulcers and strictures are well known, dry scooping ingestion of pre-workout powder as an etiology has not been described. Though caffeine may be the predominant content in such powders, the exact composition and ratios of other constituents, including amino acids, are less clear. Complete abstinence from ingestion of the pre-workout formulation and the use of a proton pump inhibitor therapy led to significant clinical and endoscopic recovery over a 4-week period. A thorough history of ingestions, including supplements, is critical when unraveling emerging etiologies of esophageal ulcerations.
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Affiliation(s)
| | | | - Rishika Navlani
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ishita Dalal
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ranita Sharma
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Payal Dave
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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8
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Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
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Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
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9
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Xie W, An L, Liu Z, Wang X, Fu X, Ma J. Therapeutic Effect of Polaprezinc on Reflux Esophagitis in the Rat Model. Dig Dis Sci 2023:10.1007/s10620-023-07990-6. [PMID: 37335414 DOI: 10.1007/s10620-023-07990-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND/AIMS To explore the protective effects and therapeutic mechanism of Esomeprazole (PPI), polaprezinc granule (PZ), and PPI + PZ on reflux esophagitis (RE) in the rat model. METHODS Wistar rats were randomly divided into 9 groups, which contain the control group, the acid cessation group (0.7% HCl, Q3D × 4), and the acid persistence group (0.7% HCl, Q3D × 11). PPI was administered by gavage at 8 mg·kg-1 body weight and PZ was administered by gavage at 120 mg·kg-1 body weight once a day for 15 days. The gastric cardia tissue of the feeding tube was observed under the light microscope, and the levels of interleukin-8 (IL-8) and prostaglandin E2 (PGE2) were measured by ELISA. The expression of EGFR, Akt, p-Akt, and p-mTOR was detected by Western blot. RESULTS The ELISA results showed that the levels of IL-8 and PGE2 were significantly increased in the model group, but decreased in all groups after treatment. In the acid cessation group, PZ treatment had the most significant effect on reducing IL-8 levels and PPI + PZ treatment had the most significant effect on reducing PGE2 levels. In the acid persistence group, the PPI treatment had the most significant effect on reducing the levels of IL-8 and PGE2, and the PZ treatment could also significantly reduce their levels, close to the normal value. Western blot results showed that the expression of PI3K/Akt/mTOR pathway protein was increased in the model group, while its expression was decreased after treatment. CONCLUSIONS Polaprezinc has a significant therapeutic effect on RE in rats, which can reduce the levels of IL-8 and PGE2 and downregulate the expression of PI3K/Akt/mTOR signal pathway protein. The efficacy of polaprezinc in the treatment of reflux esophagitis is comparable to that of PPI, and the combination of them is more effective in the reflux esophagitis treatment.
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Affiliation(s)
- Wenbo Xie
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, 130000, China
| | - Lu An
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, 130000, China
| | - Zhaoyang Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xindi Wang
- Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, Liaoning Province, China
| | - Xueqi Fu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, 130000, China
| | - Junfeng Ma
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, 130000, China.
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10
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Zhou Y, Su Y, Li Z, Wu C, Sun W, Wang C. Analysis of the clinical characteristics of dabigatran-induced oesophagitis. Eur J Hosp Pharm 2023; 30:e24-e28. [PMID: 34301743 PMCID: PMC10086715 DOI: 10.1136/ejhpharm-2021-002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/12/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Dabigatran-induced oesophagitis has emerged in recent years. However, the incidence and clinical characteristics of patients with dabigatran-induced oesophagitis have not yet been clarified. The aim of this study was to examine the clinical characteristics of the disease. METHODS A retrospective analysis was undertaken of the literature on dabigatran-induced oesophagitis in Chinese and English from 2008 onwards. RESULTS There were 20 men (74.07%) and seven women (25.93%) in the study; their median age was 75 years (range 37-90). The main clinical symptoms were dysphagia (42.31%), odynophagia (26.92%), retrosternal pain (23.08%) and heartburn (23.08%). Endoscopy mainly showed sloughing mucosal casts (14 cases, 56%), ulcers (8 cases, 32%) and erosion (6 cases, 24%). The main injury sites were the mid to lower oesophagus (32%) and the mid oesophagus (32%). Withdrawal of dabigatran or giving the correct medication regimen resulted in rapid recovery of clinical symptoms from 1 day in some patients and up to 4 weeks, and mucosal recovery (2-5 weeks) in a median time of 3 weeks (range 0.29-48) in all patients. CONCLUSIONS Oesophagitis is a rare complication of dabigatran with a good prognosis. Patients should be given proper medication instructions to prevent the occurrence of dabigatran-induced oesophagitis.
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Affiliation(s)
- Yulu Zhou
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yanhong Su
- Department of Pharmacy, Yinan County Hutou Town Health Center, linyi, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Cuifang Wu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
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Dawra S, Behl P, Srivastava S, Manrai M, Chandra A, Kumar A, Kumar A, Tevatia MS. Non-neoplastic disorders in an aging gut: concise review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023. [DOI: 10.1186/s43162-023-00189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AbstractThe spectrum of gastrointestinal (GI) issues in the older population varies from common physiological age-related changes to devastating, less common sinister pathological illness. GI system has direct exposure to external environment. Thus, it is modeled to embrace the pathophysiological changes that occur due to interaction with external factors. Gastrointestinal tract (GIT) per se is more resilient to aging as compared to other organ systems. On the other hand, elderly may present with a large plethora of GI symptoms. This presents a challenge to all echelons of medical consultation for accurate attribution for the aging process or pathophysiological causation of GI symptoms. This dichotomy leads to hindrance in adequate and appropriate treatment of GI ailments. In GI system, non-neoplastic disorders are far more common than neoplastic disorders. Hence, it becomes imperative to understand the aging evolution of the GI system and management of GI disorders in the older population.
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12
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Bonnichsen MH, Tschuchnigg M, Post JJ, Bye W. Pill related oesophagitis due to tenofovir disproxil fumarate/emtricitabine (Truvada) HIV pre-exposure prophylaxis. Intern Med J 2022; 52:1099-1100. [PMID: 35718737 DOI: 10.1111/imj.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/16/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Mark H Bonnichsen
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Mark Tschuchnigg
- Department of Surgical Pathology, Australian Clinical Laboratories, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - William Bye
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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13
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Costa MS, Gravito-Soares E, Gravito-Soares M, Figueiredo P. Severe drug-induced oesophagitis in a young male patient. BMJ Case Rep 2022; 15:e248291. [PMID: 35264388 PMCID: PMC8915360 DOI: 10.1136/bcr-2021-248291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Mara Sarmento Costa
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Marta Gravito-Soares
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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14
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Osadchuk MA, Osadchuk AM. Erosive and ulcerative lesions of the digestive tract: optimization of diagnosis and management tactics. TERAPEVT ARKH 2022; 94:271-276. [DOI: 10.26442/00403660.2022.02.201376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022]
Abstract
Erosive and ulcerative lesions of the digestive tract are one of the most pressing problems in the clinic of internal diseases due to the extremely widespread prevalence, the presence of severe complications, often fatal, diagnostic difficulties due to the presence of a large number of asymptomatic pathologies and difficulties in the rational choice of therapy. Particularly noteworthy is the data that during the global pandemic of Covid-19 infection, it is capable, quite often, of causing the development of erosive and ulcerative lesions of the gastrointestinal tract. In this regard, it seems important to use drugs that can not only prevent the occurrence of erosive and ulcerative lesions and strictures throughout the gastrointestinal tract, but also effectively achieve epithelialization of injuries to the mucous membrane of the oral cavity, esophagus, stomach, small and large intestine. One of them is Rebamipid-CZ, which has a fairly high safety and efficacy profile. It seems important to consider the issues of optimizing the prevention and treatment of erosive and ulcerative lesions of various parts of the gastrointestinal tract of various etiologies, taking into account the possibility of using rebamipide both as part of complex therapy and in isolation.
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15
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Yi Z, Chen C, Tuo B, Li T, Liu X. An extremely dangerous case of acute massive upper gastrointestinal bleeding: a case report. BMC Gastroenterol 2022; 22:67. [PMID: 35168558 PMCID: PMC8845279 DOI: 10.1186/s12876-022-02138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Upper gastrointestinal (GI) bleeding is a severe acute disease of gastroenterology department. Fish bone is the most common food-related foreign body. However, fish bone piercing the esophagus, causing the mediastinal abscess that corroded the left subclavian artery, resulting delayed but high-risk massive upper gastrointestinal bleeding is very rare. Case presentation We report a 54-year-old man who was diagnosed with delayed but high-risk massive upper GI bleeding that was the result of a fish bone piercing the esophagus, causing a mediastinal abscess that corroded the left subclavian artery. He was saved effectively by early and timely multidisciplinary collaboration. Conclusion A fish bone-caused mediastinal abscess that corrodes the left subclavian artery and induces delayed but high-risk massive upper GI bleeding is very rare. In addition to routine consideration of upper GI bleeding, medical history, endoscopy and CT are helpful for achieving a diagnosis. Importantly, early and timely multidisciplinary collaboration can effectively save critically ill patients.
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16
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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: 1.5] [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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17
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Nicolescu CM, Neşiu A, Uzum A, Laza DC, Nicolescu LC, Freiman P, Ardelean A, Ene R, Marţi TD. Esophageal ulcer associated with mild hemophilia A: case report. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:581-585. [PMID: 36588498 PMCID: PMC9926146 DOI: 10.47162/rjme.63.3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this paper, we present the case of a 68-year-old male with personal medical history of coagulopathy issues, who presented to our Emergency Room (Emergency County Hospital, Arad, Romania) with bleeding of the superior tract of the digestive system; the case was difficult to manage, thus warranting the intervention of the Department of Gastroenterology. Endoscopy was performed to localize the site of bleeding and to stop the hemorrhage. This procedure was not successful. The patient was transferred to our Intensive Care Unit where different medications, such as proton pump inhibitor, hemostatic agent and prokinetic drugs were administered. Unfortunately, our attempt to stop bleeding failed; this led us to expand our investigation. We focused on a possible hemophilia as the cause of bleeding, which was confirmed as hemophilia A through the coagulometry test after a period of three days. Patient medical history and coagulation test led us to believe that this is a very rare case of a mild hemophilia A. Finally, the correction of Factor VIII deficiency and repeated endoscopic hemostasis clip was able to stop patients bleeding and ensured a favorable clinical evolution of the patient.
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Affiliation(s)
- Cristian Mircea Nicolescu
- Department of Gastroenterology, Emergency County Hospital of Arad, Romania; ; Department of Orthopedics and Traumatology, Emergency Clinical Hospital, Bucharest, Romania;
| | - Alexandru Neşiu
- Department of Biology and Life Sciences, Vasile Goldiş Western University of Arad, Romania , Department of Urology, Emergency County Hospital, Arad, Romania
| | - Amelia Uzum
- Department of Gastroenterology, Emergency County Hospital, Arad, Romania , Department of Medicine, Faculty of Medicine, Vasile Goldiş Western University of Arad, Romania
| | | | - Laura Corina Nicolescu
- Department of Medicine, Faculty of Medicine, Vasile Goldiş Western University of Arad, Romania , Department of Physical Medicine and Rehabilitation, Emergency County Hospital, Arad, Romania
| | - Paul Freiman
- Department of Dental Medicine, Vasile Goldiş Western University of Arad, Romania
| | - Andrei Ardelean
- Department of Medicine, Faculty of Medicine, Vasile Goldiş Western University of Arad, Romania , Department of General Surgery, Emergency County Hospital, Arad, Romania
| | - Răzvan Ene
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Teodora Daniela Marţi
- Department of Medicine, Faculty of Medicine, Vasile Goldiş Western University of Arad, Romania , Department of Microbiology, Emergency County Hospital, Arad, Romania
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18
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Tanaka T, Aoki Y, Mizushiro N. L-arginine supplement-induced esophagitis in an adolescent boy. Pediatr Int 2022; 64:e15379. [PMID: 36200327 DOI: 10.1111/ped.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 01/05/2023]
Affiliation(s)
| | - Yoshihiro Aoki
- Department of Pediatrics, Aizawa Hospital, Matsumoto, Japan
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19
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Roro GM, Folvik G, Louis L, Bane A. Drug-induced esophageal injuries with an atypical presentation mimicking acute coronary syndrome. BMC Gastroenterol 2021; 21:486. [PMID: 34930138 PMCID: PMC8686213 DOI: 10.1186/s12876-021-02063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pill-induced esophageal injury may cause severe complications if not diagnosed in a timely fashion. The condition is under-recognized and under-reported, and some patients present with atypical clinical or endoscopic features mimicking other common conditions. If the diagnosis is missed the patient will continue to take the offending drug, potentially worsening the illness. We present a case in which acute coronary syndrome was the initial working diagnosis leading to a delay in diagnosis of doxycycline-induced esophageal injury. The patient developed multiple esophageal ulcers and hemorrhage. Case presentation A 50-year-old male driver with a history of hypertension and dyslipidemia was brought to the emergency department with complaints of severe retrosternal chest pain, vomiting, diaphoresis and syncope. On initial evaluation, acute coronary syndrome was considered due to the clinical presentation and history of cardiovascular risk factors. Electrocardiogram and serum troponins were normal. On the second day of his admission, the patient developed odynophagia and bloody vomitus. Esophagogastroduodenoscopy revealed extensive esophageal ulcerations with hemorrhage. The patient was taking Doxycycline capsules for an acute febrile illness. Doxycycline is the oral medication most commonly reported to cause esophageal injury. Doxycycline was discontinued, and the patient was treated with intravenous omeprazole and oral antacid suspension. The patient improved, was discharged after 6 days of hospitalization, and reported resolution of all symptoms at an outpatient follow-up visit 3 weeks later. Conclusion Medication-induced esophageal injury can present with atypical symptoms mimicking acute coronary syndrome. This condition should be included in the initial differential diagnosis of patients presenting with acute chest pain, especially those taking oral medications known to cause esophageal injury.
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Affiliation(s)
- Guda Merdassa Roro
- Division of Gastroenterology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Geir Folvik
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Liu Louis
- Gastroenterology, Sinai Health System and University Health Network, University of Toronto, Toronto, Canada
| | - Abate Bane
- Division of Gastroenterology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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20
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Hu SW, Chen AC, Wu SF. Drug-Induced Esophageal Ulcer in Adolescent Population: Experience at a Single Medical Center in Central Taiwan. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121286. [PMID: 34946231 PMCID: PMC8708022 DOI: 10.3390/medicina57121286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/10/2021] [Accepted: 11/20/2021] [Indexed: 01/07/2023]
Abstract
Background and Objectives: Drug-induced esophageal ulcer is caused by focal drug stimulation. It may occur in adults and children. Limited research is available in pediatric patients with drug-induced esophageal ulcer; therefore, we designed this study to determine the characteristics of this disease in this population. Materials and Methods: Thirty-two pediatric patients diagnosed with drug-induced esophageal ulcers from a hospital database of upper gastrointestinal tract endoscopies were included. After treatment, patients were followed for 2 months after upper gastrointestinal endoscopy. Results: Female patients were predominant (56.2%/43.8%). The mean age of patients was 15.6 years (median, 16 years; interquartile range, 2 years). Doxycycline was administered in most cases (56.3%); other drugs were dicloxacillin, amoxicillin, clindamycin, L-arginine, and nonsteroidal anti-inflammatory drugs. Doxycycline was associated with kissing ulcers. Esophageal ulcers induced by nonsteroidal anti-inflammatory drugs were more often associated with gastric or duodenal ulcers. The most common location was the middle-third of the esophagus (78.1%). Patients were treated with proton pump inhibitors, sucralfate, or H2-blockers. The mean duration for which symptoms lasted was 9.2 days. No esophageal stricture was found in 24 patients who were followed for 2 months after upper gastrointestinal endoscopy. Conclusions: The authors suggest informing patients to take medicine with enough water (approximately 100 mL) and enough time (15–30 min) before recumbency, especially high-risk drugs, such as doxycycline or nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- Shu-Wei Hu
- Department of Pediatrics, Tungs’ Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City 435403, Taiwan;
- Division of Pediatric Hepatology and Gastroenterology, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404327, Taiwan;
| | - An-Chyi Chen
- Division of Pediatric Hepatology and Gastroenterology, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404327, Taiwan;
- School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung City 404328, Taiwan
| | - Shu-Fen Wu
- Division of Pediatric Hepatology and Gastroenterology, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404327, Taiwan;
- School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung City 404328, Taiwan
- Correspondence: ; Tel.: +886-4-22052121 (ext. 2231)
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21
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Tesic-Rajkovic S, Radovanovic-Dinic B. Lesions in the oral cavity and esophagus caused by prescribed drugs: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:21-27. [PMID: 34747416 DOI: 10.5507/bp.2021.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
Almost all drugs, including some plant-based compounds, can have adverse effects, about 10% of which are expressed at the level of the digestive tract and in some cases resemble gastrointestinal diseases. Most commonly manifest as difficult and/or painful swallowing, nausea, vomiting, diarrhea and constipation. In rare cases, lesions caused by medications may be complicated by bleeding, strictures and perforations and can manifest in all segments of the gastrointestinal tract (GIT). The diagnosis is made from a detailed medical history and clinical examination inter alia. and best confirmed by proximal or distal endoscopy.
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Affiliation(s)
- Snezana Tesic-Rajkovic
- Faculty of Medicine, University of Nis, Serbia.,Clinic for Gastroenterology and Hepatology, University Clinical Center, Nis, Serbia
| | - Biljana Radovanovic-Dinic
- Faculty of Medicine, University of Nis, Serbia.,Clinic for Gastroenterology and Hepatology, University Clinical Center, Nis, Serbia
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22
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Ibuprofen-Associated Hemorrhagic Esophagitis in a Patient With Tetralogy of Fallot. Am J Ther 2020; 27:e614-e616. [PMID: 32773443 DOI: 10.1097/mjt.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Kaewdech A, Pattarapuntakul T, Sripongpun P. Amoxycillin-Clavulanic Acid-Induced Esophageal Ulcer: An Unusual Cause. Case Rep Gastroenterol 2020; 14:472-476. [PMID: 33173463 PMCID: PMC7588687 DOI: 10.1159/000509500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
Pill-induced esophagitis or esophageal ulcers are considered when patients have retrosternal chest pain or odynophagia following the ingestion of suspicious medications. Various drugs have been reported to induce esophageal ulcers. However, amoxycillin-clavulanic acid-induced esophagitis or esophageal ulcer has not been reported in literature. Hence, we report the case of a 30-year-old Thai male who presented with acute, severe odynophagia and retrosternal chest pain. He had a history of taking amoxycillin-clavulanic acid for 12 days. An esophagogastroduodenoscopy was performed and revealed geographic clean-based ulcers, with a kissing-ulcer appearance at the level of the mid-esophagus. A biopsy was taken and revealed inflamed granulation tissue and an ulcer with neither infection nor malignancy. Thus, the diagnosis of an amoxycillin-clavulanic acid-induced esophageal ulcer was made according to the clinicopathologic report.
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Affiliation(s)
- Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- *Apichat Kaewdech, Gastroenterology and Hepatology Unit, Department of Medicine Faculty of Medicine, Prince of Songkla University, 15, Kanchanavanich Road, Songkhla 90110 (Thailand),
| | - Tanawat Pattarapuntakul
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Pimsiri Sripongpun
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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24
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Medlicott SAC, Schell A, Medlicott JG, Adams F, Trpkov K. Doxycycline-induced spongiotic oesophagitis is associated with eosinophilic vascular degeneration. Histopathology 2020; 77:684-686. [PMID: 32533730 DOI: 10.1111/his.14177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Shaun A C Medlicott
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew Schell
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Julia G Medlicott
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Fatin Adams
- Department of Internal Medicine, Division of Gastroenterology, Alberta Health Services, Calgary, AB, Canada
| | - Kiril Trpkov
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
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25
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Tajima H, Narasaka T, Akutsu D, Suzuki H, Matsui H, Maruo K, Yamasaki H, Mizokami Y. The Risks of Exfoliative Esophagitis in Patients with Atrial Fibrillation: A retrospective observational study. Medicine (Baltimore) 2020; 99:e21681. [PMID: 32872038 PMCID: PMC7437837 DOI: 10.1097/md.0000000000021681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The aging of the population has resulted in atrial fibrillation (AF) becoming increasingly prevalent. Treatment focuses on the prevention of thromboembolism through the use of catheter ablation or drug therapy with anticoagulants, such as warfarin or direct oral anticoagulants (DOACs). Dabigatran-induced exfoliative esophagitis has been reported as a rare side effect of DOACs. Although most cases are mild, some result in severe outcomes. However, the etiology of exfoliative esophagitis remains incompletely understood. The aim of this study is to investigate the etiology of exfoliative esophagitis and identify its risk factors by observational study.The participants were 524 patients using anticoagulants who received catheter ablation for AF and subsequently underwent upper gastrointestinal endoscopy at University of Tsukuba Hospital. Exfoliative esophagitis was noted in 21 (4.0%) patients. Potential risk factors for exfoliative esophagitis were examined retrospectively by comparing patients with and without this condition across the following parameters that were extracted retrospectively from the electronic medical records: physical characteristics, comorbidities, blood-based cardiac markers, echocardiographic and endoscopic findings, and current medications.Regarding physical characteristics, patients with exfoliative esophagitis had significantly higher body weight and BMI. No association was observed between exfoliative esophagitis and comorbidities. Associations were also not found for cardiac markers, echocardiographic findings, or endoscopic findings. In terms of current medications, patients receiving oral dabigatran showed the highest prevalence of exfoliative esophagitis at 8.8% (13/148). The adjusted odds ratio of dabigatran for exfoliative esophagitis was 10.3 by multivariable logistic regression analysis.Obesity and oral dabigatran were found to be significant risk factors for exfoliative esophagitis.
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Affiliation(s)
| | | | | | | | | | | | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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26
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Nasir UM, Mozeika A, Ahmed S, Teehan S. Mucosal Deposition of Ferrous Sulfate Leading to Esophagitis Dissecans Superficialis. Am J Med Sci 2020; 361:e15-e16. [PMID: 32958164 DOI: 10.1016/j.amjms.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/25/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Umair M Nasir
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, U.S.A..
| | - Alexander Mozeika
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, U.S.A
| | - Shahida Ahmed
- Department of Pathology and Laboratory Medicine, Veterans Affair Hospital, East Orange, NJ, U.S.A
| | - Sima Teehan
- Department of Medicine, Division of Gastroenterology, Veterans Affair Hospital, East Orange, NJ, U.S.A
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27
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Masaki S, Watanabe T, Minaga K, Kamata K, Komeda Y, Kimura M, Kudo M. Possible involvement of autophagy in esophageal ulcers in anorexia nervosa. Clin J Gastroenterol 2020; 13:473-476. [PMID: 31900839 DOI: 10.1007/s12328-019-01089-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/21/2019] [Indexed: 12/18/2022]
Abstract
Although patients with anorexia nervosa (AN) present with various gastrointestinal disorders, little has been understood regarding the incidence and pathophysiology of gastrointestinal ulcers related to AN. A 20-year-old woman with a past history of AN was hospitalized for further examination of dysphagia and chest pain. Her nutritional status was very poor as evidenced by very low body mass index. Esophagogastroduodenoscopy detected longitudinal and geographical ulcers in the entire circumference of the cervical and upper esophagus. Enhanced expression of autophagy-related proteins, LC3B and p62, was seen in the esophageal epithelium surrounding the active ulcers. Expression of these autophagy markers disappeared from the esophageal epithelium soon after the nutritional rehabilitation. Given the fact that starvation and malnutrition are potent inducers for autophagy, these findings suggest that autophagy might be involved in the development of gastrointestinal ulcers in patients with AN.
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Affiliation(s)
- Sho Masaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masatomo Kimura
- Department of Diagnostic Pathology, Kindai University Hospital, Osaka-Sayama, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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28
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Syed M. Pill-induced oesophagitis. Postgrad Med J 2020; 97:349-350. [PMID: 32423921 DOI: 10.1136/postgradmedj-2020-137664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Misbahuddin Syed
- Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA
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29
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Magierowska K, Bakalarz D, Wójcik D, Korbut E, Danielak A, Głowacka U, Pajdo R, Buszewicz G, Ginter G, Surmiak M, Kwiecień S, Chmura A, Magierowski M, Brzozowski T. Evidence for Cytoprotective Effect of Carbon Monoxide Donor in the Development of Acute Esophagitis Leading to Acute Esophageal Epithelium Lesions. Cells 2020; 9:cells9051203. [PMID: 32408627 PMCID: PMC7291282 DOI: 10.3390/cells9051203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022] Open
Abstract
Exposure to acidic gastric content due to malfunction of lower esophageal sphincter leads to acute reflux esophagitis (RE) leading to disruption of esophageal epithelial cells. Carbon monoxide (CO) produced by heme oxygenase (HMOX) activity or released from its donor, tricarbonyldichlororuthenium (II) dimer (CORM-2) was reported to protect gastric mucosa against acid-dependent non-steroidal anti-inflammatory drug-induced damage. Thus, we aimed to investigate if CO affects RE-induced esophageal epithelium lesions development. RE induced in Wistar rats by the ligation of a junction between pylorus and forestomach were pretreated i.g. with vehicle CORM-2; RuCl3; zinc protoporphyrin IX, or hemin. CORM-2 was combined with NG-nitro-L-arginine (L-NNA), indomethacin, capsazepine, or capsaicin-induced sensory nerve ablation. Esophageal lesion score (ELS), esophageal blood flow (EBF), and mucus production were determined by planimetry, laser flowmetry, histology. Esophageal Nrf-2, HMOXs, COXs, NOSs, TNF-α and its receptor, IL-1 family and IL-1 receptor antagonist (RA), NF-κB, HIF-1α, annexin-A1, suppressor of cytokine signaling (SOCS3), TRPV1, c-Jun, c-Fos mRNA/protein expressions, PGE2, 8-hydroxy-deoxyguanozine (8-OHdG) and serum COHb, TGF-β1, TGF-β2, IL-1β, and IL-6 content were assessed by PCR, immunoblotting, immunohistochemistry, gas chromatography, ELISA or Luminex platform. Hemin or CORM-2 alone or combined with L-NNA or indomethacin decreased ELS. Capsazepine or capsaicin-induced denervation reversed CORM-2 effects. COHb blood content, esophageal HMOX-1, Nrf-2, TRPV1 protein, annexin-A1, HIF-1α, IL-1 family, NF-κB, c-Jun, c-Fos, SOCS3 mRNA expressions, and 8-OHdG levels were elevated while PGE2 concentration was decreased after RE. CO donor-maintained elevated mucosal TRPV1 protein, HIF-1 α, annexin-A1, IL-1RA, SOCS3 mRNA expression, or TGF-β serum content, decreasing 8-OHdG level, and particular inflammatory markers expression/concentration. CORM-2 and Nrf-2/HMOX-1/CO pathway prevent esophageal mucosa against RE-induced lesions, DNA oxidation, and inflammatory response involving HIF-1α, annexin-A1, SOCS3, IL-1RA, TGF-β-modulated pathways. Esophagoprotective and hyperemic CO effects are in part mediated by afferent sensory neurons and TRPV1 receptors activity with questionable COX/PGE2 or NO/NOS systems involvement.
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Affiliation(s)
- Katarzyna Magierowska
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
- Correspondence: (K.M.); (T.B.); Tel.: +48124211006 (T.B.)
| | - Dominik Bakalarz
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
- Department of Forensic Toxicology, Institute of Forensic Research, 31-033 Cracow, Poland
| | - Dagmara Wójcik
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Edyta Korbut
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Aleksandra Danielak
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Urszula Głowacka
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Robert Pajdo
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Grzegorz Buszewicz
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Grzegorz Ginter
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Marcin Surmiak
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
- Department of Internal Medicine, Jagiellonian University Medical College, 31-066 Cracow, Poland
| | - Sławomir Kwiecień
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Anna Chmura
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Marcin Magierowski
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
| | - Tomasz Brzozowski
- Department of Physiology, Jagiellonian University Medical College, 31-531 Cracow, Poland; (D.B.); (D.W.); (E.K.); (A.D.); (U.G.); (R.P.); (G.G.); (M.S.); (S.K.); (A.C.); (M.M.)
- Correspondence: (K.M.); (T.B.); Tel.: +48124211006 (T.B.)
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Nasir UM, Rodgers B, Panchal D, Choi C, Ahmed S, Ahlawat S. Ferrous Sulfate-Induced Esophageal Injury Leading to Esophagitis Dissecans Superficialis. Case Rep Gastroenterol 2020; 14:172-177. [PMID: 32399000 PMCID: PMC7204857 DOI: 10.1159/000506935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/02/2020] [Indexed: 12/19/2022] Open
Abstract
Medication-induced esophagitis is a well-known but relatively rare clinical diagnosis, most common in patients with preexisting esophageal dysmotility, obstruction, or altered anatomy. Esophagitis dissecans superficialis (EDS) is a rare endoscopic finding characterized by sloughing of large fragments of the esophageal mucosal lining. The causes of EDS include prior trauma, heavy smoking history, ingestion of alcoholic and hot beverages, and immunosuppression. We present a unique case of EDS secondary to ferrous sulfate-induced pill esophagitis. The patient was a 94-year-old male who presented with dysphagia to solids, odynophagia, and weight loss. Esophagogastroduodenoscopy (EGD) revealed EDS. Biopsies demonstrated vacuolar degeneration at the midlevel of the epithelium with overlying hyperkeratosis and parakeratosis, with noted black/brown pigment present at the level of the split in the epithelium. The patient was started on a liquid diet with no oral administration of pills. EGD was repeated and showed a significant improvement in esophageal mucosa and resolution of strictures. Although medication-induced esophagitis is not classically associated with EDS, specific circumstances that are associated with pill esophagitis may lead to progression to EDS. In the case of our patient, prolonged contact of ferrous sulfate to the esophageal mucosa is thought be a result of an enlarged left atrium and pulmonary arteries secondary to longstanding coronary artery disease and an enlarged left bronchus secondary to chronic obstructive pulmonary disease and right pneumonectomy. These anatomical changes likely led to an extended duration of contact and are believed to have led to erosion of the superficial esophageal mucosa, eventually progressing to EDS.
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Affiliation(s)
- Umair M Nasir
- Department of Internal Medicine, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Brandon Rodgers
- Department of Internal Medicine, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Dayna Panchal
- Department of Internal Medicine, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Catherine Choi
- Department of Internal Medicine, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | - Shahida Ahmed
- Department of Pathology and Laboratory Medicine, Veterans Affair Hospital, West Orange, New Jersey, USA
| | - Sushil Ahlawat
- Division of Gastroenterology, Department of Medicine, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
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Bestari MB, Agustanti N, Abdurachman SA. Clindamycin-Induced Esophageal Injury: Is It an Underdiagnosed Entity? CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619884055. [PMID: 31903026 PMCID: PMC6933540 DOI: 10.1177/1179547619884055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022]
Abstract
There are increased reports of pill-induced esophagitis in the past 2 decades,
with almost 100 different substances identified as the cause for more than 700
cases, and the overall incidence is estimated to be 0.004% per year. Antibiotics
are one of the major contributors for these cases, especially tetracycline and
doxycycline; other major contributors are bisphosphonates, nonsteroidal
anti-inflammatory drugs, and iron pills. Clindamycin is commonly prescribed by
physicians, yet side effect in the form of esophagitis is uncommon and mostly
documented in case report. It is possible that these cases are mostly unnoticed
due to initial consideration of common and more serious problems. Thus, patients
may be assumed to be having a severe episode of acid reflux, and it is not
routinely reported or recognized. In this case series, we presented 8 patients
with clindamycin-induced esophagitis. The initial presentation of all patients
was odynophagia, which appeared within the first day of taking the antibiotic.
All patients were subjected to endoscopic examination and ulcer was found in all
cases, in the form of localized solitary or multiple ulcers with sharply defined
borders. Patients were treated with proton pump inhibitor and sucralfate, and
the symptoms subside within 1 week. Patient education regarding the proper way
of ingesting drug seems to be the key factor in the prevention of pill-induced
esophagitis. The prevention of esophagitis is even more important with
antibiotics as adverse effect would decrease the patient compliance in
completing the regimen and would ultimately increase antibiotic resistance.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, University of Padjadjaran, Bandung, Indonesia
| | - Nenny Agustanti
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, University of Padjadjaran, Bandung, Indonesia
| | - Siti Aminah Abdurachman
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, University of Padjadjaran, Bandung, Indonesia
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Al Rawahi Y, Dutt S. Doxycycline-induced oesophageal ulcer in a teenager: A case report. J Paediatr Child Health 2019; 55:1499-1500. [PMID: 31290206 DOI: 10.1111/jpc.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Yusriya Al Rawahi
- Department of Gastroenterology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Department of Paediatrics, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shoma Dutt
- Department of Gastroenterology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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Severe Chest Pain due to N-Acetylcysteine-Induced Esophagitis. Case Rep Med 2019; 2019:8057259. [PMID: 31772584 PMCID: PMC6854984 DOI: 10.1155/2019/8057259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/12/2019] [Accepted: 09/24/2019] [Indexed: 01/07/2023] Open
Abstract
We report an unusual case of severe chest pain caused by N-acetylcysteine-induced esophagitis. An 81-year-old Chinese man with a history of interstitial lung disease was admitted to our hospital with intermittent arrhythmia that began 5 days ago. The patient presented with complaints of cough, sputum, and shortness of breath. Cefminox injections and N-acetylcysteine tablets were prescribed to improve respiratory symptoms. The patient developed severe chest pain and odynophagia 4 hours after swallowing the N-acetylcysteine tablet while in the decubitus position. Upper gastrointestinal endoscopy revealed four discrete areas of ulcerations measuring approximately 1 cm at the midesophageal level. The distance between the foci and the incisors was approximately 24 cm. The patient continued the N-acetylcysteine orally, which was administered in powdered form with more water while in the upright position. Pantoprazole and hydrotalcite were also administered to the patient. The symptoms subsided, and a follow-up endoscopy after 20 days showed that the ulcers healed. This case highlights that seemingly safe drugs such as N-acetylcysteine can lead to severe chest pain if ingested inappropriately.
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Pill-induced esophagitis caused by ingesting excessive caffeine tablets. Clin J Gastroenterol 2019; 13:334-339. [PMID: 31646430 PMCID: PMC7239815 DOI: 10.1007/s12328-019-01055-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022]
Abstract
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.
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Nativ-Zeltzer N, Bayoumi A, Mandin VP, Kaufman M, Seeni I, Kuhn MA, Belafsky PC. Validation of the PILL-5: A 5-Item Patient Reported Outcome Measure for Pill Dysphagia. Front Surg 2019; 6:43. [PMID: 31396520 PMCID: PMC6667828 DOI: 10.3389/fsurg.2019.00043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/08/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives: Pill dysphagia is common and costly with a significant risk of pill retention, caustic injury, and poor medication compliance. The purpose of this investigation was to determine the validity and reliability of the PILL-5, a self-administered patient reported outcome measure (PROM) to quantify the degree of pill (tablet and capsule) dysphagia. The PILL-5 is a 5-item questionnaire with a maximum symptom score of 20. Methods: The PILL-5 was administered to 190 patients with dysphagia referred for videofluoroscopic esophagography (VFE). Construct validity was assessed by comparing PILL-5 composite scores to delayed barium tablet transit on VFE. Normative data was obtained by administering the instrument to a cohort of healthy community based volunteers. Internal consistency was assessed with the Cronbach alpha. Test/retest reliability was determined by administering the instrument to the same cohort of patients at two time points. Results: The mean PILL-5 was 5.6 (±4.9) for persons with dysphagia and 1.6 (±2.7) for healthy volunteers (p < 0.001). The internal consistency of the instrument was high (Cronbach alpha = 0.85). The mean PILL-5 was 4.3 (±4.1) for patients with normal transit and 7.6 (±5.3) for patients with delayed barium tablet transit on esophagography, indicating excellent criterion based validity (p < 0.001). Reproducibility was high with an intraclass correlation coefficient of 0.83 (p < 0.001). Conclusions: Healthy individuals report some degree of swallowing difficulty with pills. Normative data suggest that a PILL-5 > 6 is abnormal (mean + 2 SD). The instrument demonstrated excellent criterion based validity and reliability. The PILL-5 is the first validated patient reported outcome measure for pill dysphagia.
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Affiliation(s)
- Nogah Nativ-Zeltzer
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Ahmed Bayoumi
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Van Pierre Mandin
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Matthew Kaufman
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Indulaxmi Seeni
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, Center for Voice and Swallowing, University of California Davis School of Medicine, Sacramento, CA, United States
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Review of Drug-induced Injury in Mucosal Biopsies From the Tubular Gastrointestinal Tract. Adv Anat Pathol 2019; 26:151-170. [PMID: 30870181 DOI: 10.1097/pap.0000000000000230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The use of prescription and over-the-counter medications is on the rise in the US population, especially among those aged 65 and over, with over 46% of the population taking at least 1 prescription medication. Given the frequency of medication use, and that the majority of these medications are taken orally, it has become increasingly relevant for pathologist examining endoscopically obtained gastrointestinal tract mucosal biopsies to consider and recognize patterns of mucosal injury associated with various drugs. Reports on injuries associated with certain classes of drugs can be scattered among different sources, making a comprehensive view of various injury patterns and the drugs known to cause them difficult to obtain. Herein, we provide a comprehensive overview of the drugs known to cause mucosal injuries in the tubular gastrointestinal tract organized by the organ involved and the prominent pattern of injury.
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Yamamoto K, Kishino M, Nakamura S, Tokushige K. Symptoms and Upper Gastrointestinal Mucosal Injury Associated with Bisphosphonate Therapy. Intern Med 2019; 58:1049-1056. [PMID: 30626809 PMCID: PMC6522418 DOI: 10.2169/internalmedicine.1271-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022] Open
Abstract
Objective The incidence of osteoporosis is increasing with the rapid aging of the Japanese population. Bisphosphonates are first-line agents used for the treatment of osteoporosis, but they can cause upper gastrointestinal mucosal injury. This study investigated symptoms and upper gastrointestinal mucosal injury associated with oral bisphosphonates. Methods Symptoms were evaluated using the F-scale questionnaire, and esophageal mucosal injury and gastroduodenal ulceration were assessed by endoscopy. Patients were stratified by the type of bisphosphonate (alendronate, risedronate, or minodronate), treatment schedule (once weekly or every four weeks), and the concomitant use of other medications [antithrombotic agents, nonsteroidal anti-inflammatory drugs (NSAIDs), or acid suppressants]. Patients The subjects included 221 patients treated with oral bisphosphonates for at least one month. Results The median F-scale total score was 4 (0-34), reflux score was 2 (0-20), and the mean dyspepsia score was 2 (0-16). Endoscopy showed esophageal mucosal injury of Grade A or worse (Los Angeles classification) in 22/221 patients (10.0%) and gastroduodenal ulcers in 9 patients (4.1%). The dyspepsia score in patients who took minodronate every four weeks was significantly lower (p<0.05) in comparison to patients who took other bisphosphonates. The dyspepsia score was significantly higher (p<0.05) and mucosal injury was significantly more frequent in patients who also used antithrombotic agents and NSAIDs. Conclusion Symptoms and upper gastrointestinal mucosal damage were not necessarily frequent or severe in patients treated with bisphosphonates. However, the concomitant use of bisphosphonates with antithrombotic agents and NSAIDs increased both symptoms and mucosal injury. The symptoms were milder in patients using minodronate once monthly.
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Affiliation(s)
- Kana Yamamoto
- Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Japan
| | - Maiko Kishino
- Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Japan
| | - Shinichi Nakamura
- Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Japan
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Dumic I, Nordin T, Jecmenica M, Stojkovic Lalosevic M, Milosavljevic T, Milovanovic T. Gastrointestinal Tract Disorders in Older Age. Can J Gastroenterol Hepatol 2019; 2019:6757524. [PMID: 30792972 PMCID: PMC6354172 DOI: 10.1155/2019/6757524] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
Considering an increase in the life expectancy leading to a rise in the elderly population, it is important to recognize the changes that occur along the process of aging. Gastrointestinal (GI) changes in the elderly are common, and despite some GI disorders being more prevalent in the elderly, there is no GI disease that is limited to this age group. While some changes associated with aging GI system are physiologic, others are pathological and particularly more prevalent among those above age 65 years. This article reviews the most important GI disorders in the elderly that clinicians encounter on a daily basis. We highlight age-related changes of the oral cavity, esophagus, stomach, small and large bowels, and the clinical implications of these changes. We review epidemiology and pathophysiology of common diseases, especially as they relate to clinical manifestation in elderly. Details regarding management of specific disease are discussed in detail if they significantly differ from the management for younger groups or if they are associated with significant challenges due to side effects or polypharmacy. Cancers of GI tract are not included in the scope of this article.
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Affiliation(s)
- Igor Dumic
- 1Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
- 2Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA
| | - Terri Nordin
- 2Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA
- 3Department of Family Medicine, Mayo Clinic Health System, Eau Claire WI, USA
| | - Mladen Jecmenica
- 4Gastroenterology Fellowship Program, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Tomica Milosavljevic
- 5Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
- 6School of Medicine, Belgrade University, Belgrade, Serbia
| | - Tamara Milovanovic
- 5Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
- 6School of Medicine, Belgrade University, Belgrade, Serbia
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Maesaka K, Tsujii Y, Shinzaki S, Yoshii S, Hayashi Y, Iijima H, Nakamoto K, Ohtani T, Sakata Y, Takehara T. Successful treatment of drug-induced esophageal ulcer in a patient with chronic heart failure: A case report. Medicine (Baltimore) 2018; 97:e13380. [PMID: 30508933 PMCID: PMC6283205 DOI: 10.1097/md.0000000000013380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Although esophageal compression due to cardiomegaly may be a risk factor of drug-induced esophageal injuries (DIEIs), the causal relationship between the two conditions has not been fully demonstrated. PATIENT CONCERNS We present a case of a drug-induced esophageal ulcer caused by left atrial enlargement in a 44-year-old woman with end-stage hypertrophic cardiomyopathy. Upper gastrointestinal endoscopy showed a deep, circumferential ulcer in the middle thoracic esophagus. CT revealed that the esophagus was compressed between the enlarged left atrium (LA) and the vertebral body. In the upper gastrointestinal series, retention of contrast media was observed in the esophagus near the LA. DIAGNOSIS The ulcer was a result of potassium chloride retention in the esophagus, which was compressed by the enlarged LA. INTERVENTION After cessation of potassium chloride administration for 2 months, the ulcer healed and a stricture developed. Two years after the ulcer development, the patient underwent heart transplantation, and subsequent endoscopic balloon dilation was performed for the esophageal stricture. OUTCOMES The patient's oral intake recovered completely without any ulcer recurrence. LESSONS The case demonstrated that esophageal compression by the enlarged LA caused a drug-induced esophageal ulcer. Preventive care and treatment measures for DIEIs, including an anatomical approach, should be considered for patients with LA enlargement.
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Affiliation(s)
| | | | | | | | | | | | - Kei Nakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Zhang Y, Tong Y, Wang W, Xu L. Chest pain from pill-induced esophagitis: A rare side effect of ascorbic acid. SAGE Open Med Case Rep 2018; 6:2050313X18775004. [PMID: 29780591 PMCID: PMC5952283 DOI: 10.1177/2050313x18775004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 04/13/2018] [Indexed: 12/18/2022] Open
Abstract
Pill-induced esophagitis is a rare cause of acute chest pain. Patients likely to be affected are those with underlying esophageal disorders, those who ingest medications without a sufficient amount of water, or adopt a supine position during or shortly after swallowing medication. Esophagitis secondary to ingestion of ascorbic acid pills is extremely rare. Here, we report a case of ascorbic acid-induced esophagitis in a middle-aged adult, with no known underlying pathological abnormalities of the esophagus. Diagnosis was made based on the history and endoscopic findings. The patient fully recovered and an esophageal ulcer healed after discontinuation of ascorbic acid.
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Affiliation(s)
- Yu Zhang
- College of Medicine, Ningbo University, Ningbo, China.,Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Yarong Tong
- Department of Gastroenterology, Ninghai No.2 Hospital, Ningbo, China
| | - Weihong Wang
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
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42
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Panarelli NC. Other Forms of Esophagitis: It Is Not Gastroesophageal Reflux Disease, So Now What Do I Do? Surg Pathol Clin 2017; 10:765-779. [PMID: 29103532 DOI: 10.1016/j.path.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Esophagitis results from diverse causes, including gastroesophageal reflux, immune-mediated or allergic reactions, therapeutic complications, and infections. The appropriate clinical management differs in each of these situations and is often guided by pathologic interpretation of endoscopic mucosal biopsy specimens. This review summarizes the diagnostic features of unusual forms of esophagitis, including eosinophilic esophagitis, lymphocytic esophagitis, esophagitis dissecans superficialis, drug-induced esophageal injury, and bullous disorders. Differential diagnoses and distinguishing features are emphasized.
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Affiliation(s)
- Nicole C Panarelli
- Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10467, USA.
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Mori S, Tahashi Y, Uchida K, Ikeura T, Danbara N, Wakamatsu T, Kusuda T, Takahashi Y, Yanagawa M, Matsushita M, Ohe C, Michiura T, Inoue K, Kon M, Okazaki K. Sclerosing Esophagitis with IgG4-positive Plasma Cell Infiltration. Intern Med 2017; 56:3023-3026. [PMID: 29021429 PMCID: PMC5725855 DOI: 10.2169/internalmedicine.8095-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The patient was a 76-year-old woman who had noticed slight difficulty in swallowing in the 3 years prior to this presentation. Her dysphagia progressed while she was hospitalized following cervical cancer surgery. Esophagogastroduodenoscopy and an esophagram showed circumferential erosion and a stricture of the thoracic esophagus. Esophageal resection was performed; the resected specimens showed a stricture and wall thickening. Histologically, transmural hyperplasia, which consisted of inflammatory granulation tissue with the abundant infiltration of IgG4-positive plasma cells and lymphocytes, was observed. The patient was diagnosed with probable IgG4-related disease. IgG4-related esophageal disease presenting as esophageal lesions alone is a very rare condition.
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Affiliation(s)
- Shigeo Mori
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | - Yoshiya Tahashi
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | - Kazushige Uchida
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | - Tsukasa Ikeura
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | - Naoyuki Danbara
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | | | - Takeo Kusuda
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | - Yu Takahashi
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | - Masato Yanagawa
- Third Department of Internal Medicine, Kansai Medical University, Japan
| | | | - Chisato Ohe
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Japan
| | - Taku Michiura
- Department of Surgery, Kansai Medical University, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, Japan
| | - Masanori Kon
- Department of Surgery, Kansai Medical University, Japan
| | - Kazuichi Okazaki
- Third Department of Internal Medicine, Kansai Medical University, Japan
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Grossi L, Ciccaglione AF, Marzio L. Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”? World J Gastroenterol 2017; 23:3011-3016. [PMID: 28533657 PMCID: PMC5423037 DOI: 10.3748/wjg.v23.i17.3011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/14/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
Esophagitis is mainly a consequence of gastroesophageal reflux disease, one of the most common diseases affecting the upper digestive tract. However the esophageal mucosa can also be targeted by some infectious, systemic or chemical conditions. Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory disease, characterized by eosinophilic infiltration in the mucosa. Esophageal localization of Crohn’s disease is not very common, but it should always be considered in patients with inflammatory bowel disease complaining of upper digestive tract symptoms. There are also forms of infectious esophagitis (e.g., Herpes simplex virus or Candida albicans) occurring in patients with a compromised immune system, either because of specific diseases or immunosuppressive therapies. Another kind of damage to esophageal mucosa is due to drug use (including oncologic chemotherapeutic regimens and radiotherapy) or caustic ingestion, usually of alkaline liquids, with colliquative necrosis and destruction of mucosa within a few seconds. Dysphagia is a predominant symptom in EoE, while infectious, drug-induced and caustic damages usually cause chest pain and odynophagia. Endoscopy can be useful for diagnosing esophagitis, although no specific pattern can be identified. In conclusion when a patient refers upper gastrointestinal tract symptoms and the diagnosis of gastro-esophageal reflux disease is not convincing we should always carefully investigate the patient’s clinical history to consider possibilities other than the gastric refluxate.
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Reyes C, Hitz M, Prieto-Alhambra D, Abrahamsen B. Risks and Benefits of Bisphosphonate Therapies. J Cell Biochem 2016; 117:20-8. [PMID: 26096687 DOI: 10.1002/jcb.25266] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 12/28/2022]
Abstract
Bisphosphonates are the mainstay of osteoporosis treatment but also play a fundamental role in treating other bone diseases such as Osteogenesis Imperfecta, Pagets' disease, and in the prevention of adverse skeletal effects in certain cancers such as prostate cancer or multiple myeloma. In the last decades, the refinement of bisphosphonates and an increase in the number of new bisphosphonates commercialized has altered the clinical management of these diseases. Despite differences between randomized controlled trials and observational studies, overall all bisphosphonates licensed have proven to reduce the risk of fracture through the inhibition of bone resorption. Other beneficial effects include pain reduction in bone metastasis and potentially a decrease in mortality. However, the chronic nature of most of these disorders implies long-term treatments, which can be associated with long-term adverse effects. Some of the adverse effects identified include an increased risk of atypical femur fractures, osteonecrosis of the jaw, gastrointestinal side effects, or atrial fibrillation. The harm/benefit thinking and the constant update regarding these medications are vital in the day-to-day decision-making in clinical practices. The aims of this review are to compile the basic characteristics of these drugs and outline the most important benefits and side effects and provide a clinical context as well as a research agenda to fill the gaps in our knowledge.
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Affiliation(s)
- Carlen Reyes
- GREMPAL Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Mette Hitz
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Kettegaards Alle, Hvidovre, Denmark
| | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,URFOA-IMIM and RETICEF, Parc de Salut Mar and Instituto de Salud Carlos III, Barcelona, Spain.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Holbaek Hospital, Holbaek, Denmark
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Martinez-Grandmontagne M, Nuñez-Simarro C, García-Argudo MT. [Doxycycline, always with water. Presentation of a case of oesophageal ulcer]. Semergen 2016; 43:e23-e24. [PMID: 27515728 DOI: 10.1016/j.semerg.2016.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/07/2023]
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Tey KR, Kemmerly T, Banerjee B. NSAID-induced pyloric stenosis leading to oesophageal intramucosal dissection. BMJ Case Rep 2016; 2016:bcr-2016-215777. [PMID: 27199442 PMCID: PMC4885491 DOI: 10.1136/bcr-2016-215777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We describe a rare case of a 75-year-old woman with significant non-steroidal anti-inflammatory drug (NSAID) use who presented with haematemesis. Upper endoscopy revealed a large (9 cm) intramucosal dissection of the oesophagus without extension into the gastro-oesophageal junction and a severely narrowed pylorus. We postulate that she developed pyloric stenosis due to peptic ulcer disease from chronic NSAID use. This then led to gastro-oesophageal reflux. Undigested pills in the refluxate had contacted oesophageal mucosa, leading to pill-induced oesophageal injury. This, along with vomiting, is postulated to have led to the oesophageal intramucosal dissection. She improved with conservative medical management with a clear liquid diet and proton pump inhibitors, and a follow-up upper endoscopy 1 week later showed recovery of the previously seen intramucosal dissection.
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Affiliation(s)
- Kai Rou Tey
- Department of Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Thomas Kemmerly
- Department of Gastroenterology, University of Arizona, Tucson, Arizona, USA
| | - Bhaskar Banerjee
- Department of Gastroenterology, University of Arizona, Tucson, Arizona, USA
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Abstract
Epigastric pain is an extremely common complaint in the emergency department and has an associated broad differential diagnosis. In the differential it is important to consider cardiac causes that may be mistaken for gastrointestinal disorders as well as various serious intra-abdominal causes. This article highlights the limitations in laboratory testing and guides providers through the appropriate considerations for advanced imaging. Special attention is focused on acute pancreatitis, esophageal emergencies, and peptic ulcer disease/gastritis and their associated complications.
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Affiliation(s)
- Patrick Robinson
- Virginia Tech Carilion Emergency Medicine Residency, Department of Emergency Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24016, USA.
| | - John C Perkins
- Virginia Tech Carilion Emergency Medicine Residency, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24016, USA
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Cloxacillin: A New Cause of Pill-Induced Esophagitis. Can J Gastroenterol Hepatol 2016; 2016:2904256. [PMID: 27446834 PMCID: PMC4904706 DOI: 10.1155/2016/2904256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 01/07/2023] Open
Abstract
A large variety of medications can cause pill-induced esophagitis. Herein we present a case of cloxacillin-induced esophagitis. A 66-year-old male presented with an acute onset of epigastric and retrosternal pain on the 5th day of a course of oral cloxacillin prescribed for erysipelas. Initial clinical and imaging assessment was negative and he was sent home. A few days later, he returned with persistent severe retrosternal pain; endoscopy at the same day revealed a normal upper esophagus, several small stellate erosions in the midesophagus, and a normal squamocolumnar junction with a small hiatus hernia. Treatment with esomeprazole 40 mg bid and Mucaine(R) suspension resulted in complete resolution of his symptoms. Pill-induced esophagitis may be underreported by patients, when symptoms are mild and unrecognized and/or underdiagnosed by the clinicians as a cause of retrosternal pain, odynophagia, or dysphagia. Failure of early recognition may result in unnecessary diagnostic investigations and prolongation of the patient's discomfort. This case signifies the importance of enhancing clinician awareness for drug-associated esophageal injury when assessing patients with retrosternal pain, as well as the value of prophylaxis against this unpleasant condition by universally recommending drinking enough water in an upright position during ingestion of any oral medication.
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Kim JW, Kim BG, Kim SH, Kim W, Lee KL, Byeon SJ, Choi E, Chang MS. Histomorphological and Immunophenotypic Features of Pill-Induced Esophagitis. PLoS One 2015; 10:e0128110. [PMID: 26047496 PMCID: PMC4457729 DOI: 10.1371/journal.pone.0128110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/22/2015] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to investigate histomorphological and immunophenotypic features in pill-induced esophagitis. We comparatively evaluated the histomorphological, immunophenotypic features of pill-induced esophagitis vs. reflux esophagitis, as well as clinical information and endoscopic findings. Fifty-two tissue pieces from 22 cases of pill-induced esophagitis, 46 pieces from 20 reflux esophagitis, and 16 pieces from 14 control samples were subjected to immunohistochemistry for inflammatory infiltrates (CD3 for T lymphocyte, CD20 for B lymphocyte, CD56 for NK cell, CD68 for macrophage, CD117 for mast cell) and eosinophil chemotaxis-associated proteins (Erk, leptin, leptin receptor, pSTAT3, phospho-mTOR). As a result, Histomorphology showed that a diffuse pattern of dilated intercellular spaces was more frequently observed in pill-induced esophagitis, while reactive atypia and subepithelial papillary elongation were more often found in reflux esophagitis (P < 0.05, respectively). Interestingly, intraepithelial eosinophilic microabscess, intraepithelial pustule and diffuse pattern of dilated intercellular spaces were observed in 14% (3 cases), 9% (2 cases) and 32% (7 cases) of pill-induced esophagitis, respectively, but in no cases of reflux esophagitis. Regarding intraepithelial inflammatory infiltrates in pill-induced esophagitis, T lymphocytes were the most common cells, followed by eosinophil; 11 and 7 in one x400 power field, respectively. Intraepithelial pSTAT3-positive pattern was more frequently observed in pill-induced esophagitis than in reflux esophagitis, at 45% (10 cases) versus 10% (2 cases), respectively (P < 0.05). Considering the distal esophageal lesion only, intraepithelial pustule, diffuse dilated intercellular spaces and stromal macrophages were more frequently found in distal pill-induced esophagitis, whereas reactive atypia and intraepithelial mast cells in reflux esophagitis (P < 0.05, respectively). In conclusion, diffuse dilated intercellular spaces, intraepithelial eosinophil microabscess, pustule, T lymphocytes, eosinophils, and pSTAT3 positivity can be added to histopathological features of pill-induced esophagitis, other than non-specific ulcer. Besides, distal pill-induced esophagitis may be histopathologically differentiated from reflux esophagitis.
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Affiliation(s)
- Ji Won Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byeong Gwan Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Hwan Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kook Lae Lee
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-ju Byeon
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Euno Choi
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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