Pinpoint Localized Odynophagia (PLO) as a Specific Symptom of Pill-induced Oesophagitis (PIO) in the Evaluation of Acute Retrosternal Chest Pain

Abstract

Among 1000 retrosternal chest pain patients, 450(45%) cardiovascular, 255(25.5%) respiratory, 248(24.85%) upper GI and 47(0.47%) had other system involvement. Among 248 GI patients, the frequency of symptoms was as follows: Pinpoint localized odynophagia (8.46%), non-localised odynophagia (12.09%), nausea (62.09%), vomiting (44.35%), dysphagia (3.62%), dyspepsia (13.70%) and hematemesis (0.8%). PLO, dysphagia, and hematemesis were significant symptoms of PIO (p<0.05). Endoscopic findings suggestive of PIO such as kissing ulcer, multiple small discrete ulcers, oesophageal erosions were observed in 91.30%, 47.83%, and 34.78% patients, respectively. Involvement of the middle third of esophagus was present in 74.19% and the lower third in 25.81% patients. Most of the patients with PLO had kissing oesophageal ulcer seen on endoscopy (pvalue =0.0002). The habit of consuming pill with less than 100 ml of water and consumption of night pill dose 10 minutes or less before sleeping were observed as significant risk factors for PIO (p value<0.05). PLO is a newly established and highly specific symptom of PIO of our study and it matches with kissing ulcer of the esophagus by endoscopy.

Clinical and endoscopic features of pill-induced esophagitis

“…20 Other studies also discovered that middle third of the esophagus is common site of lesions in case of pill-induced esophagitis, which was also seen in our study, where 76.3% of esophageal ulcer, and 62.5% of esophageal erosion were found in the middle third of the esophagus. 21,22 Because the aortic arch or enlarged left atrium compress the middle third of the esophagus, which makes the passage of pill difficult, pill-induced esophagitis is common there. 10 Thus, RE can be differentiated from pill-induced esophagitis based on the location of the esophageal ulcers, and individual with typical reflux esophagitis have persistent reflux symptoms, while patient with pill-induced esophagitis presents with sudden onset chest symptoms.…”

Drug-induced esophagitis: Incidence, clinical and endoscopic findings, and management

“…Since 1970, >650 cases of drug-induced esophagitis caused by >30 drugs were reported worldwide. Approximately 50% of causative agents include tetracycline, doxycycline, and clindamycin (1)(2)(3)(4)(5)(6). Esophageal lacerations are observed 22fold more commonly among patients using capsules than in those using tablets because capsule formulations show easier adherence to the esophageal surface (7).…”