Ulceración esofágica por ingestión de doxiciclina / Doxycycline induced esophageal ulceration

La ulceración esofágica por ingestión de doxiciclina es una de las causas más frecuentes de lesión esofágica. Ha sido subdiagnosticada y escasamente reconocida en dermatología. El dolor retroesternal, la odinofagia de aparición brusca y el antecedente de ingesta de doxiciclina u otros fármacos son características que facilitan su diagnóstico. Puede presentar complicaciones serias, como hemorragias, estenosis y mediastinitis.

Esophageal ulceration due to ingestion of doxycycline is one of the most frequent causes of esophageal injury. It has been underdiagnosed and scarcely recognized in dermatology. Retrosternal pain, sudden odynophagia and a history of doxycycline or other drugs intake are some of the characteristics that lead to diagnosis. It may cause severe complications such as bleeding, stenosis and mediastinitis.

Faringo-íleo-colo anastomosis con suplemento vascular microquirúrgico en reconstrucción del tracto digestivo superior / Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for surgical reconstruction of the upper digestive tract

Resumen Introducción Los pacientes sometidos a desconexión total con cierre al nivel del seno piriforme debido a necrosis completa del esófago y estómago después de la ingestión cáustica representan un desafío quirúrgico para restablecer la ingestión oral y la calidad de vida. Objetivo El objetivo de este trabajo es presentar la experiencia con un caso clínico con necrosis total de esófago y estómago posingestión de cáuticos por lo que fue inicialmente sometido a esofagectomía y gastrectomía total. Método La reconstrucción del tracto digestivo superior se efectuó mediante una faringo-íleo-colo anastomosis, con suplemento de irrigación sanguínea arterial y drenaje venoso mediante técnica de anastomosis microquirúrgica. Resultados No se observaron complicaciones postoperatorias mayores y en el resultado a largo plazo se logra alimentación oral normal con una recuperación nutricional adecuada y buena calidad de vida. Conclusión Esta es un procedimiento a plantear en pacientes con estenosis faríngea sin posibilidad de reemplazo esofágico con procedimientos menos complejos.

Introduction Patients submitted to total esophagectomy and gastrectomy with complete closure of pharinx due to necrosis after caustic ingestion are a challenging surgical setting for reconstruction of upper digestive transit. Objective The objective of this paper is to present a clinical case and surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy. Method Reconstruction of digestive transit was reestablished by means of a pharyngo-ileo-colonic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Results There were not major postoperative complications and at long term follow-up, normal oral nutrition and quality of life improvement was observed. Conclusion This is a surgical procedure for treatment of patients with pharyngeal strictures without any possibility to indicate other less complex procedures.

Esophageal candidiasis--an adverse effect of inhaled corticosteroids therapy.

Over the last few decades, inhaled corticosteroids (ICs) became the cornerstone in the treatment of persistent asthma. Their use improved asthma control, decreased mortality and also minimized adverse reactions associated with systemic steroid. Esophageal candidiasis is a rare complication resulting from the use of ICs. Although, in recent years, as their prescriptions has increased, more cases have been reported, especially in Japan. Listed are 4 case reports regarding esophageal candidiasis in asthmatic patients associated with inhaled budesonide administration. In the cases reported herein, the use of a different device of dry powder budesonide might have favored esophageal drug deposition and Candida infection. Patients denied using systemic corticosteroids in the previous 6 months. Furthermore, none of the patients presented Diabetes mellitus, malignant disease, HIV infection, or other immunosuppressive conditions. We conclude that patients treated with high doses of ICs are at higher risk of developing esophageal candidiasis. These patients should undergo upper gastrointestinal endoscopy whenever they present symptoms. Nevertheless, we must keep in mind that infection might also be asymptomatic and esophageal candidiasis prevalence may be higher than that reported thus far.

Benznidazole-induced ultrastructural and biochemical alterations in rat esophagus.

Benznidazole (Bz) is a drug used in the chemotherapy of the acute and intermediate phases of Chagas' disease (American Trypanosomiasis), an endemic parasitic disease afflicting more than 16 million people in Latin America. Serious toxic side effects of Bz have been reported in treated human beings and in experimental animals. Bz toxicity would be linked to its nitroreductive bioactivation to reactive intermediates and to the corresponding amine known to occur in vivo and mediated by different enzymatic systems. In the present study the presence of Bz nitroreductases in rat esophagus and the occurrence of Bz induced esophageal cell injury are described. Already 1 and 3 h after an intragastric Bz administration to Sprague-Dawley male rats (240-260 g body weight) at a dose of 100 mg/kg esophageal levels of the drug were 66.4+/-4.0 and 149.2+/-14.3 nmol per g tissue, respectively. The esophageal mucosa homogenates exhibited Bz nitroreductase activity attributable to the participation of cytochrome P450 reductase and xanthine oxidoreductase (XOR). The ultrastructural observation of esophageal tissue from Bz treated animals 24 h after its administration evidenced: detachment and conglomeration of polyribosomes, reduction in the presence of desmosomes and of the amount of bacteria on its surface. The potential significance of these alterations is not fully clear at present. However, these deleterious effects might be additive or synergistic with those induced by the evolution of the disease.

[Esophagus-enteric anastomosis ulceration caused by alendronate]. / Ulceração de anastomose esôfago-entérica causada por alendronato.

BACKGROUND: Alendronate sodium is an aminobisphosphonate indicated for the treatment of osteoporosis in post-menopausal women and has been associated with esophagitis in many reports. Esophageal stenosis, gastrointestinal symptoms as dyspepsia, nausea, vomiting and abdominal pain could be present. OBJECTIVE: Report a case of a patient who underwent total gastrectomy with Y-en-Roux anastomosis for a gastric carcinoid tumor and developed an esophagus-enteric anastomosis ulceration after the use of alendronate. PATIENT AND METHOD: A 63-year-old woman started medical therapy with alendronate in a dose of 10 mg daily. After a period of one month of medical treatment with this drug she began to complain of dysphagic symptoms and abdominal pain. She was submitted to endoscopic examination that showed an esophageal ulceration, an enteric ulceration of the anastomosis and an esophageal stenosis. RESULTS: Medical treatment with alendronate was discontinued and the symptom of abdominal pain disappeared. The intensity of dysphagia has decreased. The ulcerated lesion remitted although esophageal stenosis did not. The patient was subsequently treated with esophagus-enteric anastomosis dilation. She improved in her general state and nowadays she is free of symptoms. CONCLUSION: Alendronate sodium could cause lesions of the inferior esophageal portion or in distal segments of the gastrointestinal tube, in patients with a fast gastrointestinal transit. Special attention must be given to gastrectomized patients that use this drug because of the possibility to develop mucosal lesions in the enteric anastomosed part and its fearful complications as stenosis.

[Esophagogastric acute injury caused by a chemical agent]. / Lesão aguda esôfago--gástrica causada por agente químico.

UNLABELLED: Treatment of chemical agent ingestion remain controversial. The incidence of these episodes has increased over the several last decades due to a variety reasons. PURPOSE: To analyze the occurrence, complications and results of the treatment of chemically induced esophagogastric injury. METHODS: Twenty-one adult patients with chemically induced esophagogastric injury were retrospectively studied. The patients were admitted up to 23 days after ingestion of a chemical agent to the Emergency Department of Santa Casa of Sao Paulo University Hospital from August, in a 12-year period. The mean age was 32.1 years. Eleven patients were of the female gender, which attempted suicide. Soda was the most ingested agent (76.2%), muriatic acid was present in three cases (14.3%) followed by one case of sulfur acid and another one of ammonia (4.8% each). RESULTS: Injuries of the Larynx and Pharynx were frequently associated with those of the esophagus, accounting for 18 cases (85.7%). Esophageal, gastric and duodenal injuries were assessed and classified according to endoscopic features. Five cases each of severe esophageal or gastric lesions were present. CONCLUSION: Treatment and outcome varied and suggested placement of esophageal tube to be harmful. Global mortality rate was 28.6% with the highest rate related to esophageal injuries of the third degree.

Lesäo aguda esôfago-gástrica causada por agente químico / Chemically induced esophagogastric acute injury

O tratamento da ingestão de agentes químicos corrosivos continua controverso. A incidência desses episódios tem aumentado nas últimas décadas por várias razões. OBJETIVO: Analisar a ocorrência, as complicações e os resultados do tratamento da lesão esôfago - gástrica causada por agentes químicos. MÉTODOS: Foram estudados retrospectivamente 21 pacientes adultos com lesão esôfago-gástrica, causada por ingestão de substância química, admitidos até 23 dias após o episódio, no Serviço de Emergência da Santa Casa de Misericórdia de São Paulo num período de 12 anos. A média de idade foi 32,1 anos e 11 doentes pertenciam ao sexo feminino, as quais mais freqüentemente tinham intenções suicidas. A soda cáustica foi o produto mais ingerido (76,2 por cento), ingestão de ácido muriático ocorreu em três casos (14,3 por cento), amoníaco e ácido sulfúrico em um caso (4,8 por cento) cada. RESULTADOS: As lesões faríngeas e laríngeas estiveram freqüentemente associadas às lesões de esôfago, presentes em 18 casos (85,7 por cento). As lesões esofágicas, gástricas e duodenais foram avaliadas e classificadas por endoscopia. Lesões graves esofágicas ou gástricas estiveram presentes em cinco casos cada. CONCLUSÃO: O tratamento e os resultados foram variados, mas sugeriram que a sondagem esofágica foi prejudicial. A mortalidade global foi 28,6 por cento, mais elevada na lesão esofágica grau 3.

Ulcera esofágica inducida por medicamentos / Esophageal ulcer induced by oral drugs

La úlcera esofágica inducida por medicamentos ha sido descrita desde hace muchos años; se conocen más de 30 píldoras que pueden causar daño a la mucosa esofágica. Algunos antibióticos y los antiinflamatorios no esteroideos (AINEs), son los agentes más nocivos para la mucosa del esófago. A estos agentes agresores, recientemente, se ha agregado el alendronato sódico usado en el tratamiento de la osteoporosis. El objeto de la presente comunicación es describir las características clínicas y endoscópicas de la úlcera esofágica producída por medicamentos. Se reportan 13 pacientes con úlcera esofágica diagnosticada por endoscopía de los cuales 8 fueron causadas por alendronato sódico, 2 por tetraciclina y 1 por doxiciclina, piroxicam y zidovudina respectivamente por odinofagia y disfagia. Las úlceras se localizaron en el tercio medio e inferior del esófago. En ninguno de los pacientes se encontraron lesiones significativas en el estómago. El estudio histopatológico excluyó la presencia de monilia y de inclusiones virales. Todos los pacientes fueron tratados con supresión del agente agresor y con inhibidores de la bomba de protones y de alcalinos. A las ocho semanas se confirmó endoscópicamente la cicatrización de las úlceras

Esophageal ulcer and alendronate

Objective: To describe a case of esophageal ulcer associated with the use of alendronate. Case Report: This is the fifth case ever described in the literature according to our bibliographic review. In our patient, the association between the drug and the esophageal lesions was masked by the presence of a hiatal hernia, potentially a cause of the esophageal lesion. The persistence of the lesions despite high doses of anti-reflux therapy called attention to the possibility of the relationship. The esophageal lesion healed soon after suspension of alendronate. Discussion: The authors present a review of the literature and point to the need for diagnostic investigation, to suspend such a drug from patients who experience dyspeptic symptoms while using it.

Ulceras esofágicas inducidas por doxiciclina / Doxycycline induced esophageal ulcers

Las tetraciclinas están descritas como antibióticos que suelen producir úlceras esofágicas. Objetivo. Ver el comportamiento de este tipo de úlceras, así como la respuesta al manejo con sucralfato. Método. Es un estudio retrospectivo de los últimos dos años donde se revisaron los casos de odinofagia y disfagia sometidos a endoscopia con antecedentes de ingesta reciente de doxiciclina. Todos fueron tratados suspendiendo la droga, mientras la gran mayoría recibieron tratamiento adicional con sucralfato 1 g cada ocho horas. Resultados. Once pacientes tuvieron como indicación: enfermedad pélvica inflamatoria, acné, infecciones urinarias y respiratorias. El síntoma más común fue odinofagia, presentándose aproximadamente 6 días después de iniciado el tratamiento con varios factores contribuyentes bien comprobados como ingesta antes de acostarse y con poco líquido. Las úlceras se caracterizaron por ser múltiples y localizadas principalmente en el tercio medio. La sintomatología en general cedió 3.7 días después de suspender los medicamentos, mientras aquellos con sucrafalto no mostraron menor duración de los síntomas. Conclusiones. Debemos ser conscientes de la inducción de úlceras por estos medicamentos, basando su tratamiento en la suspensión del antibiótico, recordando que el sucralfato puede ser parte del tratamiento ya que ha demostrado su adherencia a úlceras y lesiones esofágicas, aunque su uso no ha demostrado significancia clínica. Por ende debemos explicar las medidas prevención, como tomarlas con suficiente volumen de agua, en posición, como tomarlas con suficiente volumen de agua, en posición supina y tener precaución especial en ancianos y pacientes con patología anatómica y/o de motilidad esofágica

Ulcera esofágica inducida por metronidazol. Informe de un caso / Metronidazole induced esophageal ulcer

Una mujer de 25 años de edad se presentó con odinofagia y dolor retroesternal de aparición súbita. Había ingerido metronidazol 500 mg cada 8 horas durante 3 días previos y la última tableta fue ingerida la noche anterior sin líquido antes de dormir. La esofagoscopía demostró dos úlceras circunferenciales en el tercio medio del esófago. El tratamiento consistió en suspender el metronidazol, tomar sucralfato pulverizado 2 g cada 12 horas y dieta líquida con curación clínica y endoscópica a los 7 días. Consideramos importante informar este caso dada la administración frecuente de este medicamento en México

Esophageal ulcer and alendronate.

OBJECTIVE: To describe a case of esophageal ulcer associated with the use of alendronate. CASE REPORT: This is the fifth case ever described in the literature according to our bibliographic review. In our patient, the association between the drug and the esophageal lesions was masked by the presence of a hiatal hernia, potentially a cause of the esophageal lesion. The persistence of the lesions despite high doses of anti-reflux therapy called attention to the possibility of the relationship. The esophageal lesion healed soon after suspension of alendronate. DISCUSSION: The authors present a review of the literature and point to the need for diagnostic investigation, to suspend such a drug from patients who experience dyspeptic symptoms while using it.

[Metronidazole-induced esophageal ulcer. A case report]. / Ulcera esofágica inducida por metronidazol. Informe de un caso.

A 25 years old female, previously in good health, complained of odinophagia and retrosternal pain. The last 3 days, she has been ingesting metronidazole 500 mg t.i.d. Last pill was swallowed the night before without liquids, at bed time. Esophagoscopy showed two ulcers in the middle portion of the esophagus. The patient stopped the medication, received liquid diet and sucralfate 2 g b.i.d. Clinically and endoscopically healing was achieved one week later. This case is important due to the high frequency of metronidazole prescription in Mexico.

[Doxycycline-induced esophageal ulcers]. / Ulceras esofágicas inducidas por doxiciclina.

UNLABELLED: Tetracycline is known as one of the antibiotics that induce esophageal ulcers. PURPOSE: Understand how these ulcers may behave and respond to treatment with sucralfate. METHOD: During the last two years we studied all patients complaining of dysphagia and odinophagia with an upper GI endoscopy, who were taking doxycycline in the last few days. All of them discontinued the drug once the diagnosis was done and most of them were treated also with sucralfate, 1 g tid. RESULTS: Eleven patients took doxycycline prescribed for: pelvic inflammatory disease, acne, urinary tract and pulmonary infections. Odinophagia was the most common symptom over the next few days of treatment with some risk factors previously documented, such as taking pills just before bedtime and with a small amount of water. The esophageal ulcers were multiple and located mainly in the middle esophageal third. Symptoms disappeared 3.7 days after the medication was stopped, while those taking sucralfate did not change the period of symptoms. CONCLUSIONS: Physicians must be aware of the doxycycline induced esophageal ulcers and discontinuation of the antibiotic as the main treatment, while sucralfate even though has shown to cover these ulcers, does not change the outcome. Therefore, they must encourage then patients to take the pills with enough liquid, in supine position and have special attention to the elderly and those with any kind of esophageal disease.

Ulceras esofágicas producidas por medicamentos: informe de un paciente / Esophageal ulcers produced by drugs: report of a patient

Se describe un caso de un paciente quien despúes de la ingesta de varios comprimidos de naproxen, un antiinflamatorio no esteroide, presentó disfagia y dolor retoesternal muy severo, con irradiación a la espalda. La esofagoscopía mostró una zona de ulceraciones superficiales y edema a unos 28 cm de la arcada dentaria. La suspensión de la medicación y la administración de gel de hidróxido de aluminio y metoclopramida permitieron la rápida solución del problema. En la literatura se encuentran varias comunicaciones incluyendo hasta el momento unos 26 medicamentos potencialmente peligrosos para la mucosa esofágica. Se discuten los posibles mecanismos de producción de este tipo de lesiones

Ulceras do esôfago associadas à doxiciclina: apresentaçäo de 4 casos / Esophageal ulcers associated with doxycycline: report of 4 cases

Relata-se 4 casos de úlceras de esôfago associadas ao uso de cápsulas de doxiciclina. Todos os pacientes apresentaram dor retroesternal intensa, de instalaçäo súbita, que piorava com ingestäo de sólidos e líquidos. A endoscopia revelou úlceras múltiplas em todos os casos. Os pacientes em uso de doxiciclina devem ser instruídos a ingerirem o medicamento com bastante líquido e evitar de deitar após a ingestäo do mesmo