Oesophageal injury suspected to be due to doxycycline ingestion

Abstract

Doxycycline induced oesophageal injury (DIEI) has contributed to 27% of the global burden of drug induced oesophageal injury. We report 21 cases of DIEI detected over a one year period.Cases were defined as sudden onset -chest pain, dysphagia and odynophagia within a few hours to days after taking doxycycline, confirmed by UGIE, with improvement on withdrawal of doxycycline. The majority was in the 20 -30 year age group and was female. The commonest symptoms were dysphagia and odynophagia. The mean time to symptoms from ingestion of doxycycline was 2.5 days. Majority of ulcers were in the mid oesophagus. Our case series highlights a preventable adverse drug reaction, which may have been avoided by giving simple advice to the patient.

Drug-induced esophageal ulcers: Case series and the review of the literature

“…Allowing detection of the mucosal changes, taking biopsy sampling, and intervening in bleeding and other complications of the esophagus, upper endoscopy is the first choice for both diagnosis and the treatment (2,5,11,18). In the upper endoscopy, we found that most of the ulcers were located in the middle third of the esophagus, which is compatible with the literature (2,13). Although the histopathological examination of PE is rarely pathognomonic, it is generally nonspecific and includes mostly benign ulcer and acute inflammatory changes (12,16,(22)(23)(24).…”

“…When the clinical presentations of the patients are taken into consideration, odynophagia, retrosternal pain, and dysphagia are the most encountered symptoms reported, with varying frequencies (2,6,8,11,13). In our study, the most frequent symptom was odynophagia, while hematemesis and melana were rarely primarily the reason for the application.…”

“…In our study, remarkably, female gender dominance was seen (70.9%). In the literature, most of the cases ranged between ages 20 to 40, while PE can be seen in different ages with different drugs (9,11,13,17). Most of our patients were young individuals, less than 40, and in their reproductive age, and they used doxycycline for indications, such as USD and acne vulgaris.…”

“…The most important drug-induced causes are the chemical structure and pharmaceutical form of the drug, because the capsule form can adhere to the esophagus and pose a higher risk than the tablet form (5,13,14,18). Capsule forms of drugs, such as doxycycline, tetracycline, clindamycin, calcium dobesilate, rifampicin, radioactive I…”

“…Besides, considering the cases with mild clinical symptoms who were misdiagnosed or diagnosed as reflux esophagitis or unreported at all, the number and frequency of etiological agents can be said to be much higher. Although a lot of cases and case series related to different types of drugs have been reported, tetracycline and its variant, doxycycline, are still being reported as the most frequent cause of PE (9)(10)(11)(12)(13).…”