Drug-induced esophagitis simulating esophageal carcinoma

Abstract

Abstract. Drug-induced esophagitis is an infrequently diagnosed but important cause of esophagitis. Damage to the esophageal mucosa can be severe and cause esophageal strictures that may appear malignant by radiographic and endoscopic criteria. The diagnosis requires a high index of suspicion and a careful review of the patient's drug history. Cessation of implicated drugs permits resolution of esophageal inflammation. Two patients with drug-induced esophagitis simulating esophageal carcinoma are presented.Key words: Esophagitis -Drug-induced esophagitis -Esophageal stricture -Iatrogenic injury. Case Reports Case 1A 72-year-old man was referred to the Johns Hopkins Swallowing Center for evaluation of dysphagia in 1983. Three years earlier, he had developed monthly episodes of dysphagia, with regurgitation of undigested solid food. Symptoms gradually increased in frequency and severity. By the time of referral, dysphagia occurred with every meal. The patient restricted his intake to liquids and soft, easily chewed solids. With these dietary restrictions, he was able to maintain his weight.Upper GI series and endoscopy at another hospital demonstrated a malignant-appearing stricture in the upper third of the esophagus. Despite the clinical diagnosis of esophageal carcinoma, multiple endoscopies to obtain histologic confirmation were negative for malignancy. A single cytologic Address reprint requests to:

Radiologic Diagnosis of Benign Esophageal Strictures: A Pattern Approach

“…The resulting strictures are usually located in the upper or midesophagus, appearing at barium examination as segmental areas of concentric narrowing (Fig 14). Rarely, however, these strictures may have a malignant appearance, necessitating endoscopy and biopsy to rule out esophageal carcinoma (30). Careful correlation with the patient's drug history is critical in such cases.…”

Drug-induced disorders of the esophagus

“…These giant ulcers are sometimes surrounded by a large surrounding mound of edema (Fig. 5); the resulting appearance can mimic that of an ulcerated esophageal carcinoma [31]. In such cases, endoscopy and biopsy may be required to rule out a malignant tumor.…”

Clinical Signs, Symptoms and Treatment of Dysphagia in the Neurologically Disabled

“…In such patients, attention should be given to the fact that oral medications must be prepared by a pharmacist in a manner which matches the consistency of the food substrate without loss of pharmacologic potency and administered at the onset of feeding. In this way, it may be possible to prevent drug-induced diffuse esophagitis (28) or localized necrosis at the site of a slowly dissolving pill or capsule (29).…”