What is Drug-Induced Esophagitis?
Drug-induced esophagitis is a condition where the lining of the esophagus, the tube that connects your throat to your stomach, gets damaged by medications. It usually is a result of the medicine directly harming the esophagus lining. Common symptoms are pain behind the breastbone, difficulty or pain when swallowing. The first occurrence of this condition was reported in 1970 when a patient developed esophageal ulcers after taking potassium chloride tablets.
Medications can harm the esophageal wall by causing a direct harmful effect on its lining, which creates a burning result due to an excessively acidic or alkaline environment. While drug-induced esophagitis can typically heal on its own, persistent cases can lead to serious complications like intense ulcers, narrowed areas in the esophagus, or even ruptures. It’s worth noting that heartburn and acid reflux disease can make drug-induced esophagitis worse. So, it’s important to understand the signs, causes, how it develops, how it’s diagnosed, and how to manage this condition.
What Causes Drug-Induced Esophagitis?
There are over 30 medicines known to potentially cause drug-induced esophagitis, a condition where your esophagus becomes inflamed due to medication. However, any medicine could potentially lead to this if conditions are right. The reason is not only related to the drug itself but also factors like not drinking enough water when taking the pills or lying down after taking them. Moreover, producing less saliva – which may happen due to certain drugs or conditions like Sjogren’s syndrome – can also play a part. In rare cases, an underlying esophageal disorder, like an undetected vascular ring or scleroderma, could make a person more susceptible to drug-induced esophagitis.
Some of the more common drugs linked to this condition include antibiotics, particularly tetracyclines like doxycycline. Other antibiotics such as clindamycin, amoxicillin, metronidazole, ciprofloxacin, rifaximin, can also cause esophagitis. Drugs called NSAIDs – such as aspirin and aceclofenac – could potentially harm the esophagus lining. Another category of drugs, bisphosphonates like alendronate and ibandronate, can contribute to this condition, although risedronate seems to cause fewer stomach and intestinal side effects.
Vitamin C (ascorbic acid), potassium chloride, and ferrous sulfate can also lead to drug-induced esophagitis, as well as acetaminophen, the blood thinner warfarin, and various chemotherapy drugs due to their effects on the mouth and throat.
Lastly, chest radiation and various other drugs such as blood pressure medication, quinidine, glimepiride, tiropramide, pinaverium bromide, and esomeprazole may also cause drug-induced esophagitis.
Risk Factors and Frequency for Drug-Induced Esophagitis
Drug-induced esophagitis is a condition affecting the esophagus, or food pipe, caused by certain medications. A four-year survey in Sweden involving 700,000 patients showed that this condition occurs in about 3.9 out of every 100,000 people each year. It’s found to be more common in women and older people, as well as in patients who take medications in capsule form. In the United States, it’s estimated there are about 10,000 cases per year. Interestingly, some cases have been reported in children too, with the youngest reported case being a three-year-old child.
- A four-year survey in Sweden of 700,000 patients showed 3.9 cases of drug-induced esophagitis per 100,000 people per year.
- Women and elderly people are more likely to be affected.
- Patients who take medications in capsule form also have a higher risk.
- Approximately 10,000 cases are reported each year in the United States.
- More than 20 cases have been reported in children, with the youngest patient being three years old.
Signs and Symptoms of Drug-Induced Esophagitis
Drug-induced esophagitis is a condition when certain medications cause inflammation in the esophagus, the tube that connects your mouth to your stomach. People with this condition may usually experience sudden and sporadic symptoms including chest pains, heartburn, difficulties or pains in swallowing (known as dysphagia and odynophagia respectively), and in rare cases, dark-colored stool due to bleeding from an esophageal ulcer. These symptoms can escalate within hours or up to 10 days of consuming the offending drug, and it can be severe enough to make swallowing even saliva painful. It usually occurs if the medication is not taken with enough water or if it is taken in a reclining position or just before sleep.
Children can also suffer from drug-induced esophagitis. Similar to adults, kids with recent medication history who show symptoms like difficulties in swallowing, chest pains, pains when swallowing, and vomiting should be checked for drug-induced esophagitis. This ordinarily happens when children consume medicine in capsule or tablet form without drinking adequate water or consuming the medicine just before bedtime. It’s important to note that the implications are generally mild for kids with this condition, but severity and mortality risks are associated specifically with iron and potassium drugs.
Testing for Drug-Induced Esophagitis
It’s crucial to accurately determine if a patient has drug-induced esophagitis in order to prevent repeated damage to the esophagus and any related complications. The diagnosis mainly relies on the patient’s symptoms and the findings from an endoscopy.
Patients who report chest pain deep behind the breastbone, difficulty, or pain while swallowing and have recently taken medicines known to cause drug-induced esophagitis can often be diagnosed based on these observations alone.
Blood tests, like a complete blood count, are usually not required unless the patient has seen blood in their vomit or stool. However, in severe cases where a patient has been vomiting and cannot swallow, a metabolic panel can be carried out. This test checks for any imbalance in the patient’s body salts and ensures they’re properly replaced.
Endoscopy, a procedure that uses a tiny camera to view the inside of the esophagus, is the gold standard for diagnosis and management of drug-induced esophagitis. It’s normally needed for patients who continue to experience symptoms a week after discontinuing the suspected medication or displaying severe but rare symptoms such as vomiting blood, difficulty swallowing, black stools, and abdominal pain.
During an endoscopy, the following are common sights in patients with drug-induced esophagitis, listed from most to least frequent: redness and thinning of the esophageal lining, ulcers, ulcers with bleeding, drug coating, stuck pill fragments, narrowing of the esophagus, and two ulcers that touch each other.
Even though a tissue sample may not necessarily be needed to diagnose drug-induced esophagitis, it could be useful in ruling out the possibility of cancer.
Also, even though a barium swallow study (which uses X-rays to see the esophagus and stomach) isn’t highly effective for diagnosing drug-induced esophagitis, it could be performed if the patient has difficulty swallowing, which is one of the symptoms a patient could present with.
Treatment Options for Drug-Induced Esophagitis
If a medication has caused irritation and inflammation in your esophagus (the tube connecting your mouth to your stomach), your doctor might suggest a few different things to help you recover and prevent further damage. This condition is known as drug-induced esophagitis.
The first step will be to stop taking the medication causing the problem, if possible. If the medication can’t be avoided entirely, your doctor might suggest taking it in a liquid form instead of a pill.
Your doctor may also recommend prescriptions to manage your symptoms. These could include:
- proton pump inhibitors (PPIs) or antacids, which can alleviate symptoms by reducing the amount of acid your stomach makes
- A medication called sucralfate, which can create a protective barrier in your esophagus
- A numbing medication like lidocaine that can be applied to the affected area to help with persistent discomfort
Occasionally, if swallowing becomes too difficult, doctors may suggest getting your nutrition through an IV for a short while, though this is not commonly needed. They’ll also advise avoiding food and drinks that are either too hot or cold, or very acidic, as these can irritate the esophagus further.
To prevent this from happening again, it may help to:
- Take pills with lots of water (at least 200-250 ml)
- Avoid lying down when taking medication
- Take pills at least 30 minutes before going to bed
- Eat after taking medicine
Fortunately, this condition is usually temporary and should start to get better a week or two after you stop taking the medication that caused the problem. In a study, when patients were followed up with a detailed examination of the esophagus called an endoscopy, they had normal or significantly healed esophagus after anywhere from two days to two months.
What else can Drug-Induced Esophagitis be?
When someone is experiencing chest pain behind the breastbone, along with trouble swallowing or pain when swallowing, there could be several potential causes since these symptoms are seen in many other health conditions as well. In such cases, understanding the patient’s medication history is crucial, as it can help distinguish if the issues are being caused by medication-related inflammation in the esophagus, or by other reasons.
For instance, a condition called eosinophilic esophagitis, which is caused by a type of white blood cell build-up on the esophagus lining, can present in similar ways to drug-induced esophagitis. The two conditions are usually differentiated based on clinical health history and specific diagnostic criteria.
Another potential cause could be Herpes esophagitis, typically seen in those with compromised immune systems like people with AIDS. This condition can cause small sores or ulcers mainly in the lower and middle esophagus. In some cases, it may affect the entire length of the esophagus. It’s diagnosed through a biopsy and viral culture test from the affected area.
Other potential explanations for the symptoms can include infectious esophagitis, such as one caused by a yeast infection in the esophagus; throat or esophagus cancer; acid reflux disease and stomach ulcer; Achalasia, a rare disorder that makes it hard for food and liquid to pass into your stomach; an unexpected heart disease with non-classic chest pain; or Acute necrotizing esophagitis, a rare and serious condition observed more frequently among elderly individuals.
What to expect with Drug-Induced Esophagitis
Drug-induced esophagitis, a condition that affects the tube connecting your throat to your stomach, usually gets better on its own with a good outlook following standard treatment. Typically, patients will no longer experience symptoms within a week of stopping the medication that caused the condition and starting treatment to ease symptoms. The lining of the esophagus usually heals within this time as well. In most instances, there’s no need for a second endoscopy or any extra steps.
Possible Complications When Diagnosed with Drug-Induced Esophagitis
Some possible complications of a gastrointestinal procedure can include:
- Bleeding from the gastrointestinal tract
- Narrowing and hardening of the esophagus, also known as stenosis and esophageal strictures
- Tearing or puncturing of the esophagus, also known as esophageal perforation
- A pooling of blood within the walls of the esophagus, referred to as an intramural esophageal hematoma
- An infection within the chest cavity, known as mediastinitis
Preventing Drug-Induced Esophagitis
Identifying drug-induced esophagitis (damage to the esophagus caused by medication) can be difficult. This is because patients often do not report minor symptoms, and health professionals may overlook the possibility if they are not aware of the patient’s drug history. Not diagnosing drug-induced esophagitis early can lead to unnecessary tests and medical examinations. Additionally, if drug-induced esophagitis is not recognized, the medication causing the damage could continue to harm the esophagus and result in complications.
To avoid this, it’s important to take medication with a good amount of water (around one cup) and to remain sitting or standing for at least 30 minutes after taking medication. This helps to prevent any potential damage to the esophagus.
