Drug-induced esophagitis: Incidence, clinical and endoscopic findings, and management

Yıl 2019, Cilt: 27 Sayı: 1, 1 - 6, 15.04.2019

Ahmet Uyanıkoğlu

https://doi.org/10.17940/endoskopi.566273

Öz

Background and Aims: Drug-induced esophagitis is a rare condition,
which presents with varying severity in terms of clinical and gastroscopic
findings. This study aimed to investigate the incidence, clinical and
endoscopic findings, and management of the disease in a prospective 1-year
follow-up period. Materials and Methods:
Overall, 4185 patients underwent esophagogastroduodenoscopy at the Endoscopy
Unit of Erzurum Education and Research Hospital between February 2010 and February
2011. Among these, the patients diagnosed with drug-induced esophagitis were
followed up prospectively. Results:
Among patients who underwent esophagogastroduodenoscopy, 1926 (46%) were males with
a mean age of 47.8±18.1 years (range, 12–100 years). In total, 760 patients (18%)
were diagnosed with esophagitis, of which five had drug-induced esophagitis (0.012%
of gastroscopies, 0.65% of esophagitis). All patients presented with symptoms of
retrosternal pain, odynophagia, and dysphagia. Four patients were young women, whereas
the remaining patient was an elderly man; based on the medical history and esophagogastroduodenoscopy
findings, patients diagnosed with esophagitis were using doxycycline,
tetracycline, and tramadol hydrochloride capsules. Drugs that were considered to
be the causative agents of esophagitis were discontinued, and proton pump
inhibitors were administered parenterally or orally. The patients recovered
without any complications. Conclusion:
Drug-induced esophagitis is considered to be a rare condition, presenting with varying
esophagogastroduodenoscopy findings and severe esophagitis in some cases. Discontinuing
the causative agent and administering proton pump inhibitors are sufficient to
manage the condition.

Anahtar Kelimeler

Drug-induced esophagitis, incidence, treatment

İlaca bağlı özofajit: İnsidans, klinik ve endokospik bulgular ve yönetimi

Öz

Giriş ve Amaç: İlaca bağlı özofajit nadir görülen bir
antite olup, değişik derecede klinik ve özofagogastroduodonoskopik bulgularla
prezente olur. Bir yıllık periodda görülme sıklığı, klinik ve gastroskopik özelliklerin
incelenmesi amaçlanmıştır. Gereç ve
Yöntem: Şubat 2010-Şubat 2011 yılları arasında Erzurum Eğitim ve Araştırma
Hastanesinde gastroskopisi yapılan 4185 hastada, ilaca bağlı özofajit saptanan
hastalar prospektif olarak takip edildi. Bulgular:
Özofagogastroduodonoskopik yapılan hastaların 
yaş ortalamsı 47.8±18.1 (dağılım 12-100) yaş olup, 1926 (%46)’sı
erkekti. Hastaların 760 tanesinde (%18) özofajit saptandı. Hastaların 5
tanesinde (özofagogastroduodonoskopik yapılanların %0.012’si, özofajitlerin
%0.65’i) ilaca bağlı özofajit tesbit edildi. Tüm hastaların retrosternal ağrı,
disfaji ve odinofaji yakınmaları vardı. Bu hastaların 4 tanesi genç kadın, 1
tanesi yaşlı erkek olup, hastalara doksisiklin, tetrasiklin ve tramodol hidroklorür
alım hikayeleri ve gastroskopi bulguları ile tanı konuldu. Tanı konulduktan
sonra sebeb olan ilaçlar kesilerek, enteral veya parenteral proton pompa
inhibitörü başlandı. Takiplerde hiçbir hastada komplikasyon gelişmedi. Sonuç: İlaca bağlı özofajit sık görülen
biri klinik antite olmayıp, hastalar değişik derecelerde özofagogastroduodonoskopik
bulgularla, bazen ciddi özofajitle prezente olur. Sebep olan ilacın kesilmesi
ve proton pompa inhibitörü tedavisi yeterli olmaktadır.

Anahtar Kelimeler

İlaca bağlı özofajit, insidans, tedavi

Kaynakça

• 1. Zografos GN, Georgiadou D, Thomas D, Kaltsas G, Digalakis M. Drug-induced esophagitis. Dis Esophagus 2009;22:633-7. 2. Jaspersen D. Drug-induced esophageal disorders: pathogenesis, incidence, prevention and management. Drug Saf 2000;22:237-49. 3. Patel DM, Patel MV, Rajput SL, Sharma KH. Pinpoint localized odynophagia (PLO) as a specific symptom of pill-induced oesophagitis (PIO) in the evaluation of acute retrosternal chest pain. Curr Drug Saf 2018;13:171-5. 4. Zezos P, Harel Z, Saibil F. Cloxacillin: A new cause of pill-induced esophagitis. Can J Gastroenterol Hepatol 2016;2016:2904256. 5. Javelot H, Michel B, Kumar D, Audibert B. Clozapine-induced esophagitis at therapeutic dose: a case report. Braz J Psychiatr 2016;38:177. 6. Zhang N, Liu XS, Li G, Liu T. Dabigatran-induced esophagitis: A frequently overlooked adverse effect. Int J Cardiol 2016;212:358-9. 7. Champel V, Jonville-Bera AP, Bera F, Autret E. Esophageal involvement after tetracycline ingestion. Therapie 1997;52:587-9. 8. Shelat VG, Seah M, Lim KH. Doxycycline induced acute erosive oesophagitis and presenting as acute dysphagia. J Assoc Physicians India 2011;59:57-9. 9. Kadayifci A, Gulsen MT, Koruk M, Savas MC. Doxycycline-induced pill esophagitis. Dis Esophagus 2004;17:168-71. 10. Grgurevia I, Marusia S, Bania M, et al. Doxycycline induced esophageal ulcers: report of two cases and review of the literature. Lijec Vjesn 2005;127:285-7. 11. Aktug N, Ural O. Doksisiklin Kullanımınz bağlı Gelişen Özofajit [Esophagitis Induced By Doxycycline Treatment]. İnfeksiyon Dergisi [Turkish Journal of Infection] 2007;21:205-9. 12. Valean S, Petrescu M, Catinean A, Chira R, Mircea PA. Pill esophagitis. Rom J Gastroenterol 2005;14:159-63. 13. Banisaeed N, Truding RM, Chang CH. Tetracycline-induced spongiotic esophagitis: a new endoscopic and histopathologic finding. Gastrointest Endosc 2003;58:292-4. 14. Genta RM, Spechler SJ, Kielhorn AF. The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. Dis Esophagus 2011;24:10-7. 15. Saçıkara M, Nazlıgül Y, Kızılca G, Bulur O. Doksisiklin özofajiti: İki Olgu nedeniyle literatürün göz¬den geçirilmesi [Doxycycline-induced esophagitis: Report of two cases and re-view of the literature]. Dicle Med J 2010;37:297-9. 16. Buyukberber M, Demirci F, Savas MC, et al. Pill esophagitis caused by telithromycin: a case report. Turk J Gastroenterol 2006;17:113-5. 17. Gairard-Dory AC, Schaller C, Mennecier B, et al. Chemoradiotherapy-induced esophagitis pain relieved by topical morphine: three cases. J Pain Symptom Manage 2005;30:107-9. 18. Kato S, Kobayashi M, Sato H, et al. Doxycycline-induced hemorrhagic esophagitis: a pediatric case. J Pediatr Gastroenterol Nutr 1988;7:762-5. 19. Bott SJ, McCallum RW. Medication-induced oesophageal injury. Survey of the literature. Med Toxicol 1986;1:449-57. 20. Gencosmanoglu R, Kurtkaya-Yapicier O, Tiftikci A, et al. Mid-esophageal ulceration and candidiasis-associated distal esophagitis as two distinct clinical patterns of tetracycline or doxycycline-induced esophageal injury. J Clin Gastroenterol 2004;38:484-9.