Abstract
The purpose of this animal study was to investigate the histopathologic consequences of esophageal exposure to a variety of medications known to be injurious to the human esophagus. Twenty-four New Zealand white rabbits were utilized. Tablets or control plastic beads were secured to a silk suture thread and positioned in the rabbit esophagus through a proximal esophagostomy and a gastrostomy. Test medications were allowed to dissolve passively on the surface of the esophageal mucosa in the anesthetized rabbits. After 1 hr of drug exposure, the rabbits were killed and the esophagus removed and examined. No gross abnormalities were detected with the exception of a mild degree of erythema at some of the exposure sites. All medications and control beads produced microscopic mucosal changes when compared to suture controls. The beads and test medications caused thinning of the epithelium and increased subepithelial edema (P < 0.05). Two changes, however, were unique to animals exposed to test medications: fraying and/or splitting of the epithelium and the presence of balloon cells (P < 0.05). Balloon cells represent damaged squamous epithelial cells recognizable by their distended, globoid shape. The prevalence of balloon cells ranged from 22% to 89% of sites exposed to drug and was most commonly associated with potassium. Of all drugs reported to cause injury to the human esophagus, potassium chloride has been reported to produce the most severe lesions, including esophageal stricture and perforation. The finding of balloon cells associated with all test drugs, in contrast to their absence in specimens exposed to control suture and beads, provides strong indication that balloon cells are an early marker of chemical injury.
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References
Pemberton J: Oesophageal obstruction and ulceration caused by oral potassium therapy. Br Heart J 32:267–268, 1970
Kikendall JM, Friedman AC, Oyewole MA, Fleischer D, Johnson LF: Pill induced esophageal injury: Case reports and review of the literature. Dig Dis Sci 28:174–182, 1983
Bonavina L, DeMeester TR, McChesney L, Schwizer W, Albertucci M, Bailey RT: Drug-induced esophageal strictures. Ann Surg 206:173–183, 1987
Jessurun J, Yardley JH, Giardiello FM, Hamilton SR: Intracytoplasmic plasma proteins in distended esophageal squamous cells (balloon cells). Modern Pathol 1:175–181, 1988
Hey H, Jorgensen F, Sorensen K, Hasselbalch H, Wamberg T: Oesophageal transit of six commonly used tablets and capsules. Br Med J 285:1717–1719, 1982
Carlborg B, Densert O: Esophageal lesions caused by orally administered drugs. An experimental study in the cat. Eur Surg Res 12:270–282, 1980
Ackerman AB: Histologic Diagnosis of Inflammatory Skin Diseases. Philadelphia, Lea and Febiger, 1978
Coruh G, Mason DY: Serum proteins in human squamous epithelium. Br J Dermatol 102:497–499, 1980
Reibel J: Immunohistochemical demonstration of plasma proteins in squamous epithelium of formalin-fixed, paraffin-embedded oral mucosa. J Oral Pathol 13:75–79, 1984
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Supported in part by a grant from the Health Future Foundation and from Creighton University Roland F. Mueller, M.D. endowment.
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Brewer, A.R., Smyrk, T.C., Bailey, R.T. et al. Drug-induced esophageal injury. Digest Dis Sci 35, 1205–1210 (1990). https://doi.org/10.1007/BF01536408
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DOI: https://doi.org/10.1007/BF01536408