Ulceración esofágica por ingestión de doxiciclina / Doxycycline induced esophageal ulceration

La ulceración esofágica por ingestión de doxiciclina es una de las causas más frecuentes de lesión esofágica. Ha sido subdiagnosticada y escasamente reconocida en dermatología. El dolor retroesternal, la odinofagia de aparición brusca y el antecedente de ingesta de doxiciclina u otros fármacos son características que facilitan su diagnóstico. Puede presentar complicaciones serias, como hemorragias, estenosis y mediastinitis.

Esophageal ulceration due to ingestion of doxycycline is one of the most frequent causes of esophageal injury. It has been underdiagnosed and scarcely recognized in dermatology. Retrosternal pain, sudden odynophagia and a history of doxycycline or other drugs intake are some of the characteristics that lead to diagnosis. It may cause severe complications such as bleeding, stenosis and mediastinitis.

Faringo-íleo-colo anastomosis con suplemento vascular microquirúrgico en reconstrucción del tracto digestivo superior / Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for surgical reconstruction of the upper digestive tract

Resumen Introducción Los pacientes sometidos a desconexión total con cierre al nivel del seno piriforme debido a necrosis completa del esófago y estómago después de la ingestión cáustica representan un desafío quirúrgico para restablecer la ingestión oral y la calidad de vida. Objetivo El objetivo de este trabajo es presentar la experiencia con un caso clínico con necrosis total de esófago y estómago posingestión de cáuticos por lo que fue inicialmente sometido a esofagectomía y gastrectomía total. Método La reconstrucción del tracto digestivo superior se efectuó mediante una faringo-íleo-colo anastomosis, con suplemento de irrigación sanguínea arterial y drenaje venoso mediante técnica de anastomosis microquirúrgica. Resultados No se observaron complicaciones postoperatorias mayores y en el resultado a largo plazo se logra alimentación oral normal con una recuperación nutricional adecuada y buena calidad de vida. Conclusión Esta es un procedimiento a plantear en pacientes con estenosis faríngea sin posibilidad de reemplazo esofágico con procedimientos menos complejos.

Introduction Patients submitted to total esophagectomy and gastrectomy with complete closure of pharinx due to necrosis after caustic ingestion are a challenging surgical setting for reconstruction of upper digestive transit. Objective The objective of this paper is to present a clinical case and surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy. Method Reconstruction of digestive transit was reestablished by means of a pharyngo-ileo-colonic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Results There were not major postoperative complications and at long term follow-up, normal oral nutrition and quality of life improvement was observed. Conclusion This is a surgical procedure for treatment of patients with pharyngeal strictures without any possibility to indicate other less complex procedures.

Caustic Injury of Upper Gastrointestinal Tract: 20 Year Experience at a Tertiary Referral Center / 대한소화기학회지

BACKGROUND/AIMS: Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. METHODS: This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). RESULTS: A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. CONCLUSIONS: In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.

Lesäo aguda esôfago-gástrica causada por agente químico / Chemically induced esophagogastric acute injury

O tratamento da ingestão de agentes químicos corrosivos continua controverso. A incidência desses episódios tem aumentado nas últimas décadas por várias razões. OBJETIVO: Analisar a ocorrência, as complicações e os resultados do tratamento da lesão esôfago - gástrica causada por agentes químicos. MÉTODOS: Foram estudados retrospectivamente 21 pacientes adultos com lesão esôfago-gástrica, causada por ingestão de substância química, admitidos até 23 dias após o episódio, no Serviço de Emergência da Santa Casa de Misericórdia de São Paulo num período de 12 anos. A média de idade foi 32,1 anos e 11 doentes pertenciam ao sexo feminino, as quais mais freqüentemente tinham intenções suicidas. A soda cáustica foi o produto mais ingerido (76,2 por cento), ingestão de ácido muriático ocorreu em três casos (14,3 por cento), amoníaco e ácido sulfúrico em um caso (4,8 por cento) cada. RESULTADOS: As lesões faríngeas e laríngeas estiveram freqüentemente associadas às lesões de esôfago, presentes em 18 casos (85,7 por cento). As lesões esofágicas, gástricas e duodenais foram avaliadas e classificadas por endoscopia. Lesões graves esofágicas ou gástricas estiveram presentes em cinco casos cada. CONCLUSÃO: O tratamento e os resultados foram variados, mas sugeriram que a sondagem esofágica foi prejudicial. A mortalidade global foi 28,6 por cento, mais elevada na lesão esofágica grau 3.

Prospective evaluation of medication-induced esophageal injury and its relation to esophageal function.

BACKGROUND: Few prospective studies are available on the incidence of medication-induced esophageal injury (MIEI). AIMS: To prospectively study the occurrence of MIEI with indomethacin and doxycycline and the predictive factors for its development. METHODS: In an operator-blinded study, 51 patients (age 16-65 y) requiring indomethacin (n = 24) or doxycycline (27) underwent symptom evaluation, endoscopy and scintigraphy before and after 7 days of therapy. MIEI was defined as de novo occurrence or worsening of pre-existing esophagitis or development of esophageal ulcer. RESULTS: Pre-therapy endoscopy was normal in 32 patients and revealed esophagitis in 19 (grade I--11, grade II--8). Post-therapy, 16 patients developed esophageal symptoms, which appeared earlier with doxycycline (2.0 [0.8] vs 4.1 [1.7] days, p = 0.016). MIEI developed in 23 patients--de novo esophagitis in 16, worsening of esophagitis in 6; 5 patients developed ulcer. Seven of 12 patients with hiatus hernia developed MIEI. Presence of pre-therapy gastroesophageal reflux disease did not predict MIEI. There was no difference in pre- or post-therapy transit values between patients with and without MIEI; patients who developed ulcers had significantly slower esophageal transit (p < 0.05). There was no difference in esophageal transit or occurrence of MIEI between patients who received indomethacin or doxycycline; however, 5 of 8 patients with hiatus hernia who received doxycycline developed MIEI (p = 0.02; relative risk 3.96 [CI 1.2-12.7]). CONCLUSIONS: 40% of patients receiving doxycycline or indomethacin developed MIEI; 10% developed ulcers. Hiatus hernia increased the risk for MIEI.

Ulcera esofágica inducida por medicamentos / Esophageal ulcer induced by oral drugs

La úlcera esofágica inducida por medicamentos ha sido descrita desde hace muchos años; se conocen más de 30 píldoras que pueden causar daño a la mucosa esofágica. Algunos antibióticos y los antiinflamatorios no esteroideos (AINEs), son los agentes más nocivos para la mucosa del esófago. A estos agentes agresores, recientemente, se ha agregado el alendronato sódico usado en el tratamiento de la osteoporosis. El objeto de la presente comunicación es describir las características clínicas y endoscópicas de la úlcera esofágica producída por medicamentos. Se reportan 13 pacientes con úlcera esofágica diagnosticada por endoscopía de los cuales 8 fueron causadas por alendronato sódico, 2 por tetraciclina y 1 por doxiciclina, piroxicam y zidovudina respectivamente por odinofagia y disfagia. Las úlceras se localizaron en el tercio medio e inferior del esófago. En ninguno de los pacientes se encontraron lesiones significativas en el estómago. El estudio histopatológico excluyó la presencia de monilia y de inclusiones virales. Todos los pacientes fueron tratados con supresión del agente agresor y con inhibidores de la bomba de protones y de alcalinos. A las ocho semanas se confirmó endoscópicamente la cicatrización de las úlceras

Esophageal ulcer and alendronate

Objective: To describe a case of esophageal ulcer associated with the use of alendronate. Case Report: This is the fifth case ever described in the literature according to our bibliographic review. In our patient, the association between the drug and the esophageal lesions was masked by the presence of a hiatal hernia, potentially a cause of the esophageal lesion. The persistence of the lesions despite high doses of anti-reflux therapy called attention to the possibility of the relationship. The esophageal lesion healed soon after suspension of alendronate. Discussion: The authors present a review of the literature and point to the need for diagnostic investigation, to suspend such a drug from patients who experience dyspeptic symptoms while using it.

Ulceras esofágicas inducidas por doxiciclina / Doxycycline induced esophageal ulcers

Las tetraciclinas están descritas como antibióticos que suelen producir úlceras esofágicas. Objetivo. Ver el comportamiento de este tipo de úlceras, así como la respuesta al manejo con sucralfato. Método. Es un estudio retrospectivo de los últimos dos años donde se revisaron los casos de odinofagia y disfagia sometidos a endoscopia con antecedentes de ingesta reciente de doxiciclina. Todos fueron tratados suspendiendo la droga, mientras la gran mayoría recibieron tratamiento adicional con sucralfato 1 g cada ocho horas. Resultados. Once pacientes tuvieron como indicación: enfermedad pélvica inflamatoria, acné, infecciones urinarias y respiratorias. El síntoma más común fue odinofagia, presentándose aproximadamente 6 días después de iniciado el tratamiento con varios factores contribuyentes bien comprobados como ingesta antes de acostarse y con poco líquido. Las úlceras se caracterizaron por ser múltiples y localizadas principalmente en el tercio medio. La sintomatología en general cedió 3.7 días después de suspender los medicamentos, mientras aquellos con sucrafalto no mostraron menor duración de los síntomas. Conclusiones. Debemos ser conscientes de la inducción de úlceras por estos medicamentos, basando su tratamiento en la suspensión del antibiótico, recordando que el sucralfato puede ser parte del tratamiento ya que ha demostrado su adherencia a úlceras y lesiones esofágicas, aunque su uso no ha demostrado significancia clínica. Por ende debemos explicar las medidas prevención, como tomarlas con suficiente volumen de agua, en posición, como tomarlas con suficiente volumen de agua, en posición supina y tener precaución especial en ancianos y pacientes con patología anatómica y/o de motilidad esofágica

Ulcera esofágica inducida por metronidazol. Informe de un caso / Metronidazole induced esophageal ulcer

Una mujer de 25 años de edad se presentó con odinofagia y dolor retroesternal de aparición súbita. Había ingerido metronidazol 500 mg cada 8 horas durante 3 días previos y la última tableta fue ingerida la noche anterior sin líquido antes de dormir. La esofagoscopía demostró dos úlceras circunferenciales en el tercio medio del esófago. El tratamiento consistió en suspender el metronidazol, tomar sucralfato pulverizado 2 g cada 12 horas y dieta líquida con curación clínica y endoscópica a los 7 días. Consideramos importante informar este caso dada la administración frecuente de este medicamento en México

Doxycline-induced esophageal ulcerations

Over a period of six years 16 patients presented to Dr. Al Mofarreh's polyclinic with drug-induced esophageal ulcerations. One patient had esophagitis without ulcerations and two patients, who declined endoscopy were not included in this analyzis. The mean age of the remaining 13 patients was 28.92 +/- 10.39 years. The mean ulcers number was 3.69 +/- 2.76. The ulcers were located at the mid-esophagus, 29.23 +/- 3.94 cm from the incisors teeth. Odynophagea, retrosternal pain and dysphagea in 13 [100%], 12[92%] and 9[69%] patients, respectively, were the most frequent presenting symptoms. All patients took a doxycycline preparation at bed time with little water. The mean elapse between the drug intake and endoscopy was 7.85 +/- 9.96 days. The symptoms resolved within a maximum of one week of antireflux treatment despite the continuation of doxycycline therapy in three patients with brucellosis. The current data confirmed the role of oral doxycycline intake, the timing and the amount of concurrent fluid in the etiology of esophageal ulcerations

Tetracycline-induced esophageal ulcer: a condition that probably more common than it appears to be.

Ten cases of tetracycline derivatives related drug induced esophageal ulceration were described. Five cases were due to minocycline and another five were due to doxycycline. Recumbent posture after drug ingestion was one of the predisposing factors. Odynophagia was the main symptom but may not be the presenting symptom. The diagnosis was easily confirmed by endoscopy. Single-contrast barium study was not sensitive for the demonstration of the esophageal ulcers. The recommended treatment includes cessation of the offending drug and symptomatic treatment. All recovered without any sequela within 3 to 11 days. The most important measure to prevent this condition is to instruct patients to take drugs in the upright position with at least 100 ml of water.

Medication induced esophageal injury.

Five patients of medication-induced esophageal injury are reported. A history of ingestion of medications preceding the onset of dysphagia was obtained in all patients. Endoscopy revealed localised mucosal ulceration with surrounding edematous mucosa at the level of the aortic arch in four, and in the retro-cardiac esophagus in one patient. The medications involved were sustained release potassium chloride, doxycycline, ibuprofen, and an unidentified antibiotic and antihypertensive (one each). Healing of the esophageal ulcers was confirmed in all the patients by endoscopy.

Candidiasis complicating sclerotherapy-induced esophageal ulcer presenting as recurrent hematemesis.

A ten year old child with extrahepatic portal venous obstruction had recurrent upper gastrointestinal bleeding after endoscopic variceal sclerotherapy. Sclerotherapy-induced esophageal ulcer complicated by candidiasis was found to be the source of bleeding. This as yet unrecognised complication of sclerotherapy requires prompt diagnosis and early antifungal therapy.

Ulceras esofágicas producidas por medicamentos: informe de un paciente / Esophageal ulcers produced by drugs: report of a patient

Se describe un caso de un paciente quien despúes de la ingesta de varios comprimidos de naproxen, un antiinflamatorio no esteroide, presentó disfagia y dolor retoesternal muy severo, con irradiación a la espalda. La esofagoscopía mostró una zona de ulceraciones superficiales y edema a unos 28 cm de la arcada dentaria. La suspensión de la medicación y la administración de gel de hidróxido de aluminio y metoclopramida permitieron la rápida solución del problema. En la literatura se encuentran varias comunicaciones incluyendo hasta el momento unos 26 medicamentos potencialmente peligrosos para la mucosa esofágica. Se discuten los posibles mecanismos de producción de este tipo de lesiones

Ulceras do esôfago associadas à doxiciclina: apresentaçäo de 4 casos / Esophageal ulcers associated with doxycycline: report of 4 cases

Relata-se 4 casos de úlceras de esôfago associadas ao uso de cápsulas de doxiciclina. Todos os pacientes apresentaram dor retroesternal intensa, de instalaçäo súbita, que piorava com ingestäo de sólidos e líquidos. A endoscopia revelou úlceras múltiplas em todos os casos. Os pacientes em uso de doxiciclina devem ser instruídos a ingerirem o medicamento com bastante líquido e evitar de deitar após a ingestäo do mesmo