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Case introduction: A 28-year-old female patient presented with severe chest pain for further examination.
The patient reported severe back pain, painful swallowing, and dysphagia for several days.
Past medical history showed that the patient had acne vulgaris and had been receiving antibiotic treatment.
There is no history of radiation, corrosive intake and other drugs.
The results of the oropharyngeal and other physical examinations were normal.
Chest x-ray examination was normal.
Laboratory examinations (including complete blood counts and chemical examinations) showed no obvious abnormalities.
Undergoing esophageal gastroduodenal endoscopy, it was found that there was a large, circumferential deep ulcer in the middle of the esophagus, with inflammation at the edges and relatively normal surrounding mucosa.
Perform multiple biopsies on the lesion.
The rest of the endoscopic examinations were normal.
What is the most likely diagnosis? A.
Lymphocytic esophagitis B.
Lichenoid esophagitis C.
Esophageal cancer D.
Diagnostic analysis of drug-induced esophagitis The correct answer is D, drug-induced esophagitis.
The detailed medical history revealed that the patient had taken doxycycline capsules 100 mg twice a day for treatment of acne vulgaris for more than two weeks.
The patient reported taking the capsule with a small amount of water before going to bed last week.
Based on the medical history, clinical manifestations, and endoscopic findings, the patient was diagnosed with drug-induced (pill-induced) esophagitis caused by doxycycline.
A biopsy from the center and edge of the ulcer revealed that the ulcer was accompanied by mixed inflammatory infiltrates.
Doxycycline was discontinued after endoscopy, and the patient was recommended to take a liquid diet, sucralfate suspension, and omeprazole.
The patient's symptoms completely resolved within 4 days, and an endoscopic follow-up examination was performed 4 weeks after admission, and it was confirmed that the ulcer had healed completely.
Knowledge class: Drug-induced esophagitis Drug-induced (pill-induced) esophagitis is the damage of the esophageal mucosa caused by drugs, which usually refers to the direct toxic effect of pathogenic drugs on the esophageal mucosa.
Common symptoms include pain behind the breastbone, difficulty swallowing, or painful swallowing.
According to reports, many drugs can cause drug-induced esophagitis, the common ones are as follows: Antibiotics: one of the most common causes of drug-induced esophagitis.
Including tetracyclines, especially doxycycline.
Other antibiotics that can cause esophagitis include clindamycin, amoxicillin, metronidazole, ciprofloxacin, and rifaximin.
Non-steroidal anti-inflammatory drugs (NSAIDs): Aspirin and aceclofenac can cause damage to the esophageal mucosa.
Bisphosphonates: including alendronate and ibandronate.
Risedronate appears to be slightly safer than adridronate in terms of gastrointestinal side effects.
Ascorbate potassium chloride and ferrous sulfate paracetamol warfarin chemotherapy regimen: dactinomycin, daunorubicin, bleomycin, methotrexate, 5-fluorouracil, cytarabine and vincristine Esophagitis caused by oropharyngeal mucositis.
Other drugs for thoracic radiation: including antihypertensive drugs, quinidine, glimepiride, tirolamide, pinaverium bromide, esomeprazole, etc.
Diagnostic methods Drug-induced esophagitis can be diagnosed based on clinical manifestations and endoscopic examination results.
For patients with retrosternal chest pain, dysphagia, or painful swallowing, there is a recent history of taking drugs known to cause drug-induced esophagitis, and the diagnosis can be made based on the history alone.
Unless there is a history of hematemesis or melena, blood tests, including a complete blood count, are usually not required.
Patients with severe illness (including vomiting and inability to swallow) should also undergo metabolic tests to check for electrolyte imbalances and to ensure that they are adequately replenished.
Endoscopy can usually confirm the diagnosis and is the gold standard for the evaluation and management of drug-induced esophagitis.
Endoscopy is required for patients whose symptoms persist after one week after discontinuation of the causative drugs or present with severe but fairly rare symptoms of hematemesis, dysphagia, melena, and abdominal pain.
Among patients diagnosed with drug-induced esophagitis, the most common endoscopy results are listed in descending order of frequency as follows: esophageal mucosal erythema and erosion ulcers and ulcers with bleeding.
Pill fragments embedded in the drug material coating stenosis and histopathological examination of kiss ulcers It may not be a necessary condition for the diagnosis of drug-induced esophagitis, but it can rule out the possibility of malignant tumors.
Barium swallow research is not very useful in evaluating drug-induced esophagitis, but it is usually used to evaluate dysphagia, which may be one of the symptoms of patients when they visit a doctor.
Treatment methods The treatment of drug-induced esophagitis includes stopping the disease-causing drugs, other supportive treatments, and life>
Discontinue disease-causing drugs.
If feasible, it is recommended to discontinue potentially corrosive oral drugs.
The pharmaceutical preparations should be changed to liquid preparations.
Short-term treatment with proton pump inhibitors (PPI) and antacids.
Studies have found that PPI has acid-suppressing properties and is very useful because acid reflux may lead to further deterioration of esophageal damage.
Sucralfate is taken orally.
It can form a local protective barrier with cell protection.
For some patients with clinical symptoms lasting several weeks to several months, lidocaine topical medication can be used to relieve the symptoms.
Patients with dysphagia can consider short-term parenteral nutrition, but it is usually not required.
Avoid irritating foods, such as extremely hot or cold or acidic foods.
The measures to prevent drug-induced esophagitis are as follows: Take the medicine with sufficient water (at least 200-250 mL).
Avoid prone position when taking the medicine.
Take the pill at least 30 minutes before going to bed.
Eat after taking the medicine.
Drug-induced esophagitis is usually transient and can improve within 1-2 weeks after stopping the disease-causing drugs.
References: [1] Kilincalp S, Yuksel I.
Severe Chest Pain, Odynophagia and Dysphagia in a Young Woman[J].
Gastroenterology.
2021 Apr 1;S0016-5085(21)00586-2.
[2] Saleem F, Sharma A.
Drug Induced Esophagitis[J].
Treasure Island (FL);StatPearls Publishing.
2021 Jan.
Contribution email: tougao@medlive.
cn
The patient reported severe back pain, painful swallowing, and dysphagia for several days.
Past medical history showed that the patient had acne vulgaris and had been receiving antibiotic treatment.
There is no history of radiation, corrosive intake and other drugs.
The results of the oropharyngeal and other physical examinations were normal.
Chest x-ray examination was normal.
Laboratory examinations (including complete blood counts and chemical examinations) showed no obvious abnormalities.
Undergoing esophageal gastroduodenal endoscopy, it was found that there was a large, circumferential deep ulcer in the middle of the esophagus, with inflammation at the edges and relatively normal surrounding mucosa.
Perform multiple biopsies on the lesion.
The rest of the endoscopic examinations were normal.
What is the most likely diagnosis? A.
Lymphocytic esophagitis B.
Lichenoid esophagitis C.
Esophageal cancer D.
Diagnostic analysis of drug-induced esophagitis The correct answer is D, drug-induced esophagitis.
The detailed medical history revealed that the patient had taken doxycycline capsules 100 mg twice a day for treatment of acne vulgaris for more than two weeks.
The patient reported taking the capsule with a small amount of water before going to bed last week.
Based on the medical history, clinical manifestations, and endoscopic findings, the patient was diagnosed with drug-induced (pill-induced) esophagitis caused by doxycycline.
A biopsy from the center and edge of the ulcer revealed that the ulcer was accompanied by mixed inflammatory infiltrates.
Doxycycline was discontinued after endoscopy, and the patient was recommended to take a liquid diet, sucralfate suspension, and omeprazole.
The patient's symptoms completely resolved within 4 days, and an endoscopic follow-up examination was performed 4 weeks after admission, and it was confirmed that the ulcer had healed completely.
Knowledge class: Drug-induced esophagitis Drug-induced (pill-induced) esophagitis is the damage of the esophageal mucosa caused by drugs, which usually refers to the direct toxic effect of pathogenic drugs on the esophageal mucosa.
Common symptoms include pain behind the breastbone, difficulty swallowing, or painful swallowing.
According to reports, many drugs can cause drug-induced esophagitis, the common ones are as follows: Antibiotics: one of the most common causes of drug-induced esophagitis.
Including tetracyclines, especially doxycycline.
Other antibiotics that can cause esophagitis include clindamycin, amoxicillin, metronidazole, ciprofloxacin, and rifaximin.
Non-steroidal anti-inflammatory drugs (NSAIDs): Aspirin and aceclofenac can cause damage to the esophageal mucosa.
Bisphosphonates: including alendronate and ibandronate.
Risedronate appears to be slightly safer than adridronate in terms of gastrointestinal side effects.
Ascorbate potassium chloride and ferrous sulfate paracetamol warfarin chemotherapy regimen: dactinomycin, daunorubicin, bleomycin, methotrexate, 5-fluorouracil, cytarabine and vincristine Esophagitis caused by oropharyngeal mucositis.
Other drugs for thoracic radiation: including antihypertensive drugs, quinidine, glimepiride, tirolamide, pinaverium bromide, esomeprazole, etc.
Diagnostic methods Drug-induced esophagitis can be diagnosed based on clinical manifestations and endoscopic examination results.
For patients with retrosternal chest pain, dysphagia, or painful swallowing, there is a recent history of taking drugs known to cause drug-induced esophagitis, and the diagnosis can be made based on the history alone.
Unless there is a history of hematemesis or melena, blood tests, including a complete blood count, are usually not required.
Patients with severe illness (including vomiting and inability to swallow) should also undergo metabolic tests to check for electrolyte imbalances and to ensure that they are adequately replenished.
Endoscopy can usually confirm the diagnosis and is the gold standard for the evaluation and management of drug-induced esophagitis.
Endoscopy is required for patients whose symptoms persist after one week after discontinuation of the causative drugs or present with severe but fairly rare symptoms of hematemesis, dysphagia, melena, and abdominal pain.
Among patients diagnosed with drug-induced esophagitis, the most common endoscopy results are listed in descending order of frequency as follows: esophageal mucosal erythema and erosion ulcers and ulcers with bleeding.
Pill fragments embedded in the drug material coating stenosis and histopathological examination of kiss ulcers It may not be a necessary condition for the diagnosis of drug-induced esophagitis, but it can rule out the possibility of malignant tumors.
Barium swallow research is not very useful in evaluating drug-induced esophagitis, but it is usually used to evaluate dysphagia, which may be one of the symptoms of patients when they visit a doctor.
Treatment methods The treatment of drug-induced esophagitis includes stopping the disease-causing drugs, other supportive treatments, and life>
Discontinue disease-causing drugs.
If feasible, it is recommended to discontinue potentially corrosive oral drugs.
The pharmaceutical preparations should be changed to liquid preparations.
Short-term treatment with proton pump inhibitors (PPI) and antacids.
Studies have found that PPI has acid-suppressing properties and is very useful because acid reflux may lead to further deterioration of esophageal damage.
Sucralfate is taken orally.
It can form a local protective barrier with cell protection.
For some patients with clinical symptoms lasting several weeks to several months, lidocaine topical medication can be used to relieve the symptoms.
Patients with dysphagia can consider short-term parenteral nutrition, but it is usually not required.
Avoid irritating foods, such as extremely hot or cold or acidic foods.
The measures to prevent drug-induced esophagitis are as follows: Take the medicine with sufficient water (at least 200-250 mL).
Avoid prone position when taking the medicine.
Take the pill at least 30 minutes before going to bed.
Eat after taking the medicine.
Drug-induced esophagitis is usually transient and can improve within 1-2 weeks after stopping the disease-causing drugs.
References: [1] Kilincalp S, Yuksel I.
Severe Chest Pain, Odynophagia and Dysphagia in a Young Woman[J].
Gastroenterology.
2021 Apr 1;S0016-5085(21)00586-2.
[2] Saleem F, Sharma A.
Drug Induced Esophagitis[J].
Treasure Island (FL);StatPearls Publishing.
2021 Jan.
Contribution email: tougao@medlive.
cn
