What is new in esophageal injury (infection, drug-induced, caustic, stricture, perforation)?

Abstract

PURPOSE OF REVIEW: We will focus separately on infectious, drug-induced and caustic injury of the esophagus and their possible complications such as stricture and perforation. RECENT FINDINGS: There has been a decrease in opportunistic esophageal infection in HIV-positive patients, in particular candidiasis, which remains an important cause of inpatient charges, length of stay and total hospital costs, and new antifungal therapy are currently explored. As far as drug-induced esophageal injury is concerned, more than 1000 cases of all cases due to nearly 100 different medications have been described during the last 10 years. However, the estimated case frequency is probably much higher and the related literature is of low quality, as cases are reported selectively and stimulated by clustering of cases, newly implicated pills or unusual complications. Finally, in the field of caustic ingestion-related injury, there has been greater understanding of geographical differences in prevalence and more frequently involved substances, choice of optimal timing for endoscopy, relationship between symptoms and severity of lesions and appropriate role of steroids and other therapies, such as the topical application of mytomicin C. SUMMARY: This update covers the most relevant papers published on the three areas of interest during the last year.

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

“…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…”

“…Most drugs can cause different variations of pill esophagitis (PE) and be presented in different spectrums of complications, such as mucosal inflammation, ulceration, bleeding, penetration, perforation on the esophagus, and even death (1)(2)(3)(4)(5)(6). First, it was described as associated with potassium chloride tablet consumption, and then, it was reported as an etiological agent of 100 different drugs and more than 1000 cases until 1999 (7,8).…”

“…Upper gastrointestinal endoscopy is the most important method for the diagnosis, differential diagnosis, follow-up, and the treatment of the complications. Histopathological evaluation is not necessary for diagnosis and has generally nonspecific findings, except that of certain agents; however, it is useful for the exclusion of malignancy (5,11,12,16).…”

“…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).…”

Oesophageal injury suspected to be due to doxycycline ingestion

“…Drug induced oesophageal injury is a well known adverse drug reaction with over 1 000 cases caused by almost 100 different drugs which have been reported in the world literature upto 1999 [1,2]. Although impressive, the numbers are considered by experts in the field to be quite small compared with the estimated case frequency [1].…”