L-arginine-induced esophagitis, report of six cases

Abstract

Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine.In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.

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.…”

“…We have identified 14 previous cases of L-arginine-induced esophagitis in Mexico, Spain, Canada, and Taiwan. [4][5][6][7][8][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. A history of preceding retrosternal discomfort or a strange feeling in the chest can be a helpful indicator of pill-induced esophagitis even in previously healthy pediatric or adolescent patients as observed in our case.…”