Drug-Induced Esophageal Ulcer in Adolescent Population: Experience at a Single Medical Center in Central Taiwan

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.

Esophageal ulcer associated with mild hemophilia A: case report

“…Another important cause in the pathogenesis of esophageal ulcers is represented by the ingestion of chemical substances, and especially drugs (antibiotics, antihypertensive, non-steroidal anti-inflammatory drugs, etc.). The incidence is estimated at 3.9 per 100 000 individuals per year [ 22 ]. Some studies claim that more than 100 drugs can cause damage to the esophagus [ 22 , 23 ].…”

“…The incidence is estimated at 3.9 per 100 000 individuals per year [ 22 ]. Some studies claim that more than 100 drugs can cause damage to the esophagus [ 22 , 23 ]. Unfortunately, in our patient, the cause of the esophageal ulcer was not identified.…”

Esophageal Dysphagia in Children: State of the Art and Proposal for a Symptom-Based Diagnostic Approach

“…Immune-mediated disorders, such as systemic sclerosis (40) and Crohn's disease can rarely involve the esophagus causing ED (41). Ongoing treatment with tablets/capsules should raise the possibility of pill-induced esophagitis especially when there is a close temporal relation (<10 days) with the use of NSAIDs, antibiotics (e.g., doxycycline, amoxicillin), L-arginine and iron, and the drug has been taken with little water at bedtime (42,43).…”

“…In IE, EGD reveals typical mucosal changes and provide for a microbiological diagnosis (39). EGD is the method of choice for detecting the characteristic features of pill-induced esophagitis which consist of single or multiple ulcers, surrounded by normal mucosa, usually located in the middle-third of the esophagus (42,43).…”

L‐arginine supplement‐induced esophagitis in an adolescent boy

“…The relatively large size of the capsule, using insufficient water to take the capsule, and lying down immediately after taking the capsule might have contributed to esophageal adhesion of the capsule and disease development. We have identified 14 previous cases of L‐arginine‐induced esophagitis in Mexico, Spain, Canada, and Taiwan 4–9 . L‐arginine supplements are easily accessible even online; therefore, clinicians should be aware of pill‐induced esophagitis as a possible etiology of unspecified erosive esophagitis.…”