Tetracycline induced esophageal ulcers. A clinical and experimental study

Carlborg, B; Densert, O.; Lindqvist, Christina

doi:10.1288/00005537-198302000-00011

Cited by 51 publications

(33 citation statements)

References 14 publications

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“…Doxycycline can damage Original Article the esophageal mucosa by its acidic structure, with a direct local caustic effect, and it also accumulates in the epithelial cells and causes damage, with an inhibiting effect on protein synthesis (20,21). In our study, doxycycline, used widely for indications, such as USD, acne, and brucellosis, was the most frequent offending drug (50%); besides, 19 different drugs leading to esophageal ulcer were identified.…”

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confidence: 61%

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

Dağ

Öztürk²,

Akin³

et al. 2014

Turk J Gastroenterol

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, by excluding other factors, 48 patients were included in the study, diagnosed as drug-induced esophagitis with their history, endoscopic view, and histopathologic evaluation. Results: There were 34 (70.9%) female and 14 (29.1%) male patients in the study, and their average ages were 35.1 and 32.4, respectively. Clinical symptoms were odynophagia (79.1%), retrosternal pain (62.5%), and dysphagia (47.9%). The reason for these symptoms for 85.5% of the patients was related to insufficient water consumption while taking the pill, taking the pill in recumbent position, or both. Tetracycline and its variant, doxycycline, were responsible for 52% of the patients, and 62.5% of the drugs were in capsule form. Ulcers were at the proximal and middle third of the esophagus in 79.2% of the patients. In the histopathologic evaluation, nonspecific acute inflammatory changes were found in 29.1% of the cases. Various proton pump inhibitors and sucralfate were used in the treatment. While no perforation and structure were detected, 1 patient died because of repetitive arterial bleeding. Conclusion: Almost every kind of drug, particularly doxycycline, can cause ulcer in the esophagus. Pill esophagitis can be prevented by warning patients about drinking water sufficiently and sitting up while taking the pill.

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confidence: 61%

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

Dağ

Öztürk²,

Akin³

et al. 2014

Turk J Gastroenterol

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“…Furthermore, drugs that have a large size and sticky surface are retained longer in the esophagus [4-6]. In addition to these a clinical and experimental study has shown that doxycycline capsules remain three times longer in the esophagus than doxycycline tablets [7]. …”

Section: Discussionmentioning

confidence: 99%

Severe odynophagia in a patient developing after azithromycin intake: a case report

et al. 2010

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IntroductionDrug-induced esophageal ulcers most commonly cause heartburn, midsternal pain and dysphagia. In our clinic azithromycin is a relative widely used antibiotic for respiratory tract infections and otitis media because of its activity against Haemophilus influenzae and atypical pathogens, and its ease of administration. After a thorough search in Pubmed the present case is the first one to report azithromycin-induced esophageal ulcer and associated symptoms in the literature.Case presentationA 61-year-old Caucasian man was admitted to our endoscopy unit for the investigation of odynophagia and retrosternal pain of new onset. His past medical history was unremarkable but had used azithromycin 500 mg/d for three days in the previous week. An upper endoscopy revealed an extensive serpiginous midesophageal ulcer in the presence of a normal squamocolumnar junction and biopsies from the edges and center of the lesion disclosed no neoplasia or infectious causes but a dense acute inflammatory infiltrate. The patient was put on a liquid diet, sucralfate proton pump inhibitor treatment and was symptom-free within two weeks. After four weeks on therapy a repeated upper endoscopic control examination demonstrated normal findings.ConclusionTo our knowledge this is the first such a case of azithromycin -induced esophageal ulceration. We think that a little time taken by the physician to warn the patients for taking every oral drug with sufficient amount of water might prevent this kind of complications.

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“…Most likely, it is related to the acidity of doxycycline in solution; a capsule dissolved in 1 0 mL of distilled water results in a pH of about 2.5. 9 When a capsule or tablet is retained in the esophagus, compression by the lower esophageal sphincter may increase the ulcerogenic potential of the continued PERPLEXING CASE CONTINUED doxycycline. Carlborg and associates9 suggested that ulceration may also be related to the dissolution rate of doxycycline.…”

Section: Discussionmentioning

confidence: 99%