Medication-induced upper gastrointestinal tract injury

Abstract

Medication-induced upper gastrointestinal (GI) tract injuries are probably fairly common, yet these injuries are rarely documented in pathology reports. Since these injuries often manifest as non-specific histological changes, making a definitive diagnosis of medication-induced injury can be challenging. Three types of evidence can assist in the establishment of a diagnosis: specific histological patterns, the presence of medication fragments in tissue, and clinical data. Histological patterns may reflect specific tissue responses to medication effects or medication toxicity. Morphological clues of medication use such as pill fragments and crystal deposition may be visible within the tissue itself. Clinical data, including medication history, endoscopic findings, and predisposing conditions can alert the pathologist to situations where medication-induced injury should merit a high ranking on the differential diagnosis list. Except for rare cases where characteristic histological changes can be diagnostic, clinical correlation is essential when diagnosing medication-induced injuries. In this review, key features of the most commonly encountered medication-induced upper GI tract injuries are briefly discussed, and a practical guide to assist the practicing pathologist in the recognition and diagnosis of these injuries is provided.

Fluoxetine-induced pill oesophagitis

“…The pills include both tablets and capsules. Medications like antibiotics, cardiac and vascular medications, non-steroidal anti-inflammatory drugs, alendronate, hydroxychloroquine and quinine are notorious for causing pill oesophagitis 2 3. Pill oesophagitis has been reported in all age groups and in both men and women.…”

Gastroprotective Effects of Grape Seed Proanthocyanidin Extracts against Nonsteroid Anti-Inflammatory Drug-Induced Gastric Injury in Rats

“…The number of gastric erosions and ulcers, and the area of the lesions were measured. The assessment of lesions was performed with reference to the histological characteristics of NSAID-induced gastritis, which were previously described by Chen et al,17 based on the following criteria: the intensity of the gastric mucosal damage was assessed based on four categories, such as normal, erosion restricted to the mucosa, ulcer invading the submucosa and ulcer invading the proper muscle layer. In each experimental animal, the most severe lesions were used for the assessment.…”

Fatal esophageal perforation caused by oral iron

“…Mechanisms of mucosal toxicity by these agents can be complex [1], due to their biological effects, caustic nature and methods of administrations. Diagnosis is based on: specific histological patterns, the presence of medication fragments in tissue and clinical data.…”

“…Since these injuries often manifest as non-specific histological changes, making a definitive diagnosis can be challenging [1].…”