Observational Study
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World J Gastroenterol. Aug 21, 2014; 20(31): 10994-10999
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10994
Clinical and endoscopic characteristics of drug-induced esophagitis
Su Hwan Kim, Ji Bong Jeong, Ji Won Kim, Seong-Joon Koh, Byeong Gwan Kim, Kook Lae Lee, Mee Soo Chang, Jong Pil Im, Hyoun Woo Kang, Cheol Min Shin
Su Hwan Kim, Ji Bong Jeong, Ji Won Kim, Seong-Joon Koh, Byeong Gwan Kim, Kook Lae Lee, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 156-707, South Korea
Mee Soo Chang, Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 156-707, South Korea
Jong Pil Im, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 110-744 Seoul, South Korea
Hyoun Woo Kang, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, 410-773 Gyeonggi-do, South Korea
Cheol Min Shin, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 463-707 Gyeonggi-do, South Korea
Author contributions: Kim SH and Jeong JB contributed equally to this work; Kim SH and Jeong JB performed the data analysis and wrote the paper; Kim JW designed this study and supervised the entire research; Koh SJ, Kim BG and Lee KL revised the manuscript for intellectual content; Chang MS performed the histopathological analysis; Kim SH, Jeong JB, Im JP, Kang HW and Shin CM obtained the data; all authors reviewed and approved the final version of the manuscript.
Correspondence to: Ji Won Kim, MD, PhD, Associate Professor, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 5 Gil 20, Boramae-Road, Dongjak-Gu, 156-707 Seoul, South Korea. kjwjor@snu.ac.kr
Telephone: +82-2-870-2221 Fax: +82-2-870-3863
Received: March 16, 2014
Revised: April 30, 2014
Accepted: May 25, 2014
Published online: August 21, 2014
Abstract

AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis.

METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patients diagnosed with malignancy, viral or fungal esophagitis were excluded. Clinical, endoscopic and pathological characteristics of patients diagnosed with drug-induced esophagitis were analyzed.

RESULTS: Seventy-eight patients were diagnosed with drug-induced esophagitis. Their mean age was 43.9 ± 18.9 years and 35.9% were male. Common symptoms were chest pain (71.8%), odynophagia (38.5%) and dysphagia (29.5%). The endoscopic location was in the middle third of esophagus in 78.2%. Endoscopic findings were ulcer (82.1%), erosion (17.9%), ulcer with bleeding (24.4%), coating with drug material (5.1%), impacted pill fragments (3.8%) and stricture (2.6%). Kissing ulcers were observed in 43.6%. The main causative agents were antibiotics and non-steroidal anti-inflammatory drugs. All the patients were treated with proton pump inhibitors (PPIs) or sucralfate, and the causative drugs were discontinued. Nineteen patients with drug-induced esophagitis were followed up with endoscopy and revealed normal findings, scars or healing ulcers.

CONCLUSION: Drug-induced esophagitis mainly presents as chest pain, odynophagia and dysphagia, and may be successfully treated with PPIs and discontinuation of the causative drug. Kissing ulcers were observed in 43.6%.

Keywords: Drug, Esophagitis, Endoscopy, Pathology, Symptoms, Kissing ulcers

Core tip: This study investigated the clinical characteristics of drug-induced esophagitis, such as the main symptoms, common endoscopic findings and main causative agents. Uniquely, kissing ulcers were observed in 43.6% of drug-induced esophagitis, which is a higher rate than in the previous reports. This might be helpful in diagnosing this rare disease. To the best of our knowledge, the present study is the first to compare the histopathological features between drug-induced esophagitis group and reflux esophagitis group.