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Pill-induced esophageal injury

Case reports and review of the medical literature

Digestive Diseases and Sciences volume 28, pages 174–182 (1983)Cite this article

Abstract

We report four cases of esophageal injury associated with the ingestion of commonly prescribed tablets or capsules. History and clinical characteristics of these cases suggest that the medications failed to transit the esophagus and acted locally to produce esophagitis. A search of English- and foreign-language medical journals documented 221 similar cases due to 26 different types of medication. While most of these esophageal injuries are self-limited and produce no morbidity beyond transient retrosternal pain, odynophagia, and dysphagia, major complications have occurred, such as mediastinal penetration, hemorrhage, and death. Patients should be counseled to take pills in an upright posture with liberal amounts of fluid well before retiring for the night.

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References

  1. Pemberton J: Oesophageal obstruction and ulceration caused by oral potassium therapy. Br Heart J 32:267–268, 1970

    Google Scholar 

  2. Juncosa L: Ulcus peptico yatrogeno del esofago. Rev Esp Enferm Apar Dig 30:457–458, 1970

    Google Scholar 

  3. Carlborg B, Kumlien A, Olsson H: Medikamentella esofagusstrikturer. Lakartidningen 75:4609–4611, 1978

    Google Scholar 

  4. Giger M, Sonnenberg A, Brandli H, Singeisen M, Guller R, Blum AL: Das tetracyclin-ulkus der speiserohre. Dtsch Med Wochenschr 103:1038–1040, 1978

    Google Scholar 

  5. Kobler E, Buhler H, Nuesch HJ, Deyhle P: Medikamentos induzierte osophagusulzera. Dtsch Med Wochenschr 103:1035–1037, 1978

    Google Scholar 

  6. Kobler E, Nuesch HJ, Buhler H, Jenny S, Deyhle P: Medikamentos bedingte Osophagusulzera. Schweiz Med Wochenschr 109:1180–1182, 1979

    Google Scholar 

  7. Evenepoel C: Slokdarmzweren door gebruik van doxycycline. Tijdschr Gastroenterol 20:293–296, 1977

    Google Scholar 

  8. Meyboom RHB: Slokdarmbeschadiging door doxycycline en tetracycline. Ned Tijdschr Geneeskd 121:1770, 1977

    Google Scholar 

  9. Bokey L, Hugh TB: Oesophageal ulceration associated with doxycycline therapy. Med J Aust 1:236–237, 1975

    Google Scholar 

  10. Schneider R: Doxycycline esophageal ulcers. Am J Dig Dis 22:805–807, 1977

    Google Scholar 

  11. Maffioli C, Segal S, Renard A, Diot J, Segal A: Ulceres oesophagiens a la doxycycline. Nouv Presse Med 8:1264, 1979

    Google Scholar 

  12. Kavin H: Oesophageal ulceration due to emepronium bromide. Lancet 1:424–425, 1977

    Google Scholar 

  13. Aarons B, Bruns BJ: Oesophageal ulceration associated with ingestion of doxycycline. NZ Med J 91:27, 1980

    Google Scholar 

  14. O'Meara TF: A new endoscopic finding of tetracycline-induced esophageal ulcers. Gastrointest Endosc 26:106–107, 1980

    Google Scholar 

  15. Kimura K, Sakai H, Ido K, et al: Drug-induced esophageal ulcer. Nippon Shokakibyo Gakkai 75:64–70, 1978

    Google Scholar 

  16. Sakai H, Seki H, Yoshida Y, Shirahata T, Ido K, Kimura K: Radiological study of drug-induced esophageal ulcer. Rinsho Hoshasen 25:27–34, 1980

    Google Scholar 

  17. Crowson TD, Head LH, Ferrante WA: Esophageal ulcers associated with tetracycline therapy. J Am Med Assoc 235:2747–2748, 1976

    Google Scholar 

  18. Schmidt-Wilcke HA: Tetracyclin-ulkus der speiserohre. Dtsch Med Wochenschr 103:2053, 1978

    Google Scholar 

  19. Djupesland G, Rolstad EA: Etsskader i oesophagus forarsaket av medikamenter. Tidsskr Nor Laegeforen 98:696–697, 1978

    Google Scholar 

  20. Khera DC, Herschman BR, Sosa F: Tetracycline-induced esophageal ulcers. Postgrad Med 68:113, 115, 1980

    Google Scholar 

  21. Burke EL: Acute oesophageal damage from one brand of tetracycline tablets. Gastroenterology 68:1022, 1975

    Google Scholar 

  22. Froese EH: Oesophagitis with clindamycin. S Afr Med J 56:826, 1979

    Google Scholar 

  23. Sutton DR, Gosnold JK: Oesophageal ulceration due to clindamycin. Br Med J 1:1598, 1977

    Google Scholar 

  24. Stillman AE, Martin RJ: Tetracycline-induced esophageal ulcerations. Arch Dermatol 115:1005, 1979

    Google Scholar 

  25. Seaman WB: The case of the antibiotic dysphagia. Hosp Pract 14:206, 208, 1979

    Google Scholar 

  26. Habeshaw T, Bennett JR: Ulceration of mouth due to emepronium bromide. Lancet 2:1422, 1972

    Google Scholar 

  27. Bennett JR: Oesophageal ulceration due to emepronium bromide. Lancet 1:810, 1977

    Google Scholar 

  28. Shepperd HWH: Iatrogenic reflux oesophagitis. J Laryngol Otol 91:171–172, 1977

    Google Scholar 

  29. Hale JE, Barnardo DE: Ulceration of mouth due to emepronium bromide. Lancet 1:493, 1973

    Google Scholar 

  30. Kenwright S, Norris ADC: Oesophageal ulceration due to emepronium bromide. Lancet 1:548, 1977

    Google Scholar 

  31. Higson RH: Oesophagitis as a side effect of emepronium. Br Med J 2:201, 1978

    Google Scholar 

  32. Kunert H: Medikamentos induzierte osophagusulzera. Dtsch Med Wochenschr 103:1278, 1978

    Google Scholar 

  33. Hughes R: Drug-induced oesophageal injury. Br Med J 2:132, 1979

    Google Scholar 

  34. Cowan RE, Wright JT, Marsh F: Drug-induced oesophageal injury. Br Med J 2:132–133, 1979

    Google Scholar 

  35. Chapman K: Emepronium bromide and the treatment of urge incontinence. Med J Aust 1:103, 1978

    Google Scholar 

  36. Collins FJ, Matthews HR, Baker SE, Stakova J: Pill-induced oesophageal injury. Br Med J 1:1673–1676, 1979

    Google Scholar 

  37. Rose JDR, Tobin GB: Drug-induced oesophageal injury. Br Med J 1:110, 1980

    Google Scholar 

  38. Lind O: Medikamentidusert osofagitt. Tidsskr Nor Lageforen 98:742, 1978

    Google Scholar 

  39. Pahakka HJ: Drug-induced corrosive injury of the esophagus. J Laryngol Otol 92:927–931, 1978

    Google Scholar 

  40. Barbier P, Pringot J, Heimann R, Fiasse R, Jacobs E: Ulcerations digestives induites par le chlorure de potassium. Acta Gastroenterol Belg 39:261–274, 1976

    Google Scholar 

  41. Lubbe WF, Cadogan ES, Kanneineyer AHR: Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement. NZ Med J 90:377–379, 1979

    Google Scholar 

  42. McCall AJ: Slow-K ulceration of oesophagus with aneurysmal left atrium. Br Med J 3:230–231, 1975

    Google Scholar 

  43. Rosenthal T, Adar R, Militianu J, Deutsch V: Esophageal ulceration and oral potassium chloride ingestion. Chest 65:463–465, 1974

    Google Scholar 

  44. Howie AD, Strachan RW: Slow release potassium chloride treatment. Br Med J 2:176, 1975

    Google Scholar 

  45. Chesshyre MH, Braimbridge MV: Dysphagia due to left atrial enlargement after mitral Starr valve replacement. Br Heart J 33:799–802, 1971

    Google Scholar 

  46. Peters JL: Benign oesophageal stricture following oral potassium chloride therapy. Br J Surg 63:698–699, 1976

    Google Scholar 

  47. Whitney B, Croxon R: Dysphagia caused by cardiac enlargement. Clin Radiol 23:147–152, 1972

    Google Scholar 

  48. Riker J, Swanson M, Schweigert B: Esophageal ulceration caused by wax-matrix potassium chloride. West J Med 128:542–543, 1978

    Google Scholar 

  49. Learmonth I, Weaver PC: Potassium stricture of the upper alimentary tract. Lancet 1:251–252, 1976

    Google Scholar 

  50. Abbarah TR, Fredell JE, Ellenz GB: Ulceration by oral ferrous sulfate. J Am Med Assoc 236:2320, 1976

    Google Scholar 

  51. Teplick JG, Teplick SK, Ominsky SH, Haskin ME: Esophagitis caused by oral medication. Radiology 134:23–25, 1980

    Google Scholar 

  52. Bohane TD, Perrault J, Fowler RS: Oesophagitis and oesophageal obstruction from quinidine tablets in association with left atrial enlargement. Aust Paediatr J 14:191–192, 1978

    Google Scholar 

  53. Mason SJ, O'Meara TF: Drug-induced esophagitis. J Clin Gastroenterol 3:115–120, 1981

    Google Scholar 

  54. Gardies A, Gevaudan J, LeRoux C, Cornet C, Warnet-Dubosca J, Viguie R: Ulcere iatrogene de l'oesophage. Nouv Presse Med 7:1032, 1978

    Google Scholar 

  55. Agdal N: Mediciniducerede esophagusskader. Ugeskr Laeger 141:3019–3021, 1979

    Google Scholar 

  56. Drug Experience Report. Spontaneous Reporting Program (1969–1980). Division of Drug Experience (HFD-210). Food and Drug Administration, 5600 Fishers Lane, Rockville, Maryland 20875

  57. Williams JG: Drug-induced oesophageal injury. Br Med J 2:273, 1979

    Google Scholar 

  58. Walta DC, Giddens JD, Johnson LF, Kelley JL, Waugh DF: Localized proximal esophagitis secondary to ascorbic acid ingestion and esophageal motor disorder. Gastroenterology 70:766–769, 1976

    Google Scholar 

  59. Lodge KV: The pathology of nonspecific oesophagitis. J Pathol Bacteriol 69:17–24, 1955

    Google Scholar 

  60. Hogan WJ, Viegos de Andriade SR, Winship DH: Ethanol-induced acute esophageal motor dysfunction. J Appl Physiol 32:755–760, 1972

    Google Scholar 

  61. Mayer EM, Grabowski CJ, Fisher RS: Effects of graded doses of alcohol upon esophageal motor function. Gastroenterology 75:1133–1136, 1978

    Google Scholar 

  62. Smith VM: Association of aspirin ingestion with symptomatic hiatus hernia. South Med J 71 (Suppl 1):45–47, 1978

    Google Scholar 

  63. Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer C, Petrie DJ: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980

    Google Scholar 

  64. Johnson LF, Rinaldo JA, Spiro HM: Endoscopic evaluation of the esophagus.In National Commission on Digestive Diseases. Report to the Congress of the United States. Vol. 4, Part 3: Report of the work groups on health care delivery. U.S. Department of Health, Education and Welfare Publication No. (NIH) 79-1886, 1979, p 373

  65. Humphries TJ, Castell DO: Pressure profile of esophageal peristalsis in normal humans as measured by direct intraesophageal transducers. Am J Dig Dis 22:641–645, 1977

    Google Scholar 

  66. Applegate GR, Malmud LS, Rock E, Reilley JR, Fisher RS: “It's a hard pill to swallow” or “Don't take it lying down.” Gastroenterology 78:1132, 1980

    Google Scholar 

  67. Evans KT, Roberts GM: Where do all the tablets go? Lancet 2:1237–1239, 1976

    Google Scholar 

  68. Schneyer LH, Pigman W, Hanahan L, Gilmore RW: Rate of flow of human parotid, sublingual and submaxillary secretions during sleep. J Dent Res 35:109–114, 1956

    Google Scholar 

  69. Pilbrant A: Ulceration due to emepronium bromide tablets. Lancet 1:749, 1977

    Google Scholar 

  70. Lauder AD: Cetiprin and oesophageal ulceration. Br Med J 2:211, 1979

    Google Scholar 

  71. Carlborg B: Biverkningar vid accidentell losning av lakemedel i esofagus och bronker. Lakartidningen 73:4201–4204, 1976

    Google Scholar 

  72. Eastwood GL, Castell DO, Higgs RH: Experimental esophagitis in cats impairs lower esophageal sphincter pressure. Gastroenterology 69:146–153, 1975

    Google Scholar 

  73. Phaosawasdi K, Malmud LS, Tolin RD, Steltzer F, Applegate G, Fisher RS: Cholinergic effects on esophageal transit and clearance. Gastroenterology 81:915–920, 1981

    Google Scholar 

  74. Burrington JD: Clinitest burns of the esophagus. Ann Thorac Surg 20:400–404, 1975

    Google Scholar 

  75. Volpicelli NA, Bedine MS, Hendrix TR: Absence of acid sensitivity in patients with benign peptic esophageal strictures. Gastroenterology 68:A-150/1007, 1975

    Google Scholar 

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Affiliations

  1. Gastroenterology and Radiology Divisions, Walter Reed Army Medical Center, OSC Box 317, Washington, D.C.

    James Walter Kikendall MD, Arnold C. Friedman MD, Morakinyo Anthony Oyewole MD, David Fleischer MD &  Lawrence F. Johnson MD

  2. the Uniformed Services University of the Health Sciences, 20012, Washington, D.C.

    James Walter Kikendall MD, Arnold C. Friedman MD, Morakinyo Anthony Oyewole MD, David Fleischer MD &  Lawrence F. Johnson MD

  3. the Gastroenterology/Hepatology Section, Veterans Administration Medical Center, Washington, D.C.

    James Walter Kikendall MD, Arnold C. Friedman MD, Morakinyo Anthony Oyewole MD, David Fleischer MD &  Lawrence F. Johnson MD

Authors
  1. James Walter Kikendall MD
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  2. Arnold C. Friedman MD
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  3. Morakinyo Anthony Oyewole MD
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  4. David Fleischer MD
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  5. Lawrence F. Johnson MD
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Kikendall, J.W., Friedman, A.C., Oyewole, M.A. et al. Pill-induced esophageal injury. Digest Dis Sci 28, 174–182 (1983). https://doi.org/10.1007/BF01315148

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  • DOI: https://doi.org/10.1007/BF01315148

Keywords

  • Public Health
  • Medical Journal
  • Major Complication
  • Esophagitis
  • Similar Case