- Donald O Castell, MD
Donald O Castell, MD
- AGA Peer Reviewer
- Professor of Medicine
- Director, Esophageal Disorders Program
- Medical University of South Carolina
Medications can induce esophageal abnormalities via both systemic effects and by causing direct esophageal mucosal injury. Systemic effects of medications that can result in esophagitis include gastroesophageal reflux and medication-induced infectious complications.
This topic will review medication-induced esophagitis from direct esophageal mucosal injury. The pathophysiology of reflux esophagitis and the clinical manifestations, diagnosis, and management of other causes of esophagitis are discussed in detail, separately. (See "Pathophysiology of reflux esophagitis" and "Clinical manifestations and diagnosis of eosinophilic esophagitis" and "Approach to the evaluation of dysphagia in adults".)
The estimated incidence of medication-induced esophagitis is 3.9 per 100,000 population per year with a mean age at diagnosis of 41.5 years [1,2]. Although medication-induced esophagitis has a higher prevalence in women, this may be due to a higher likelihood of women being treated with culprit medications rather than an underlying difference in susceptibility to medication-induced esophageal injury. Medication-induced esophagitis usually occurs at anatomical sites of esophageal narrowing. Of these, the most common site is near the level of the aortic arch (76 percent) due to extrinsic compression and physiologic reduction in the amplitude of the esophageal peristaltic wave .
Medications that cause direct esophageal mucosal injury include the following.
Antibiotics — Tetracycline, doxycycline, and clindamycin have been associated with esophagitis due to their direct irritant effect. (See 'Pathogenesis' below.)
- Kikendall JW, Friedman AC, Oyewole MA, et al. Pill-induced esophageal injury. Case reports and review of the medical literature. Dig Dis Sci 1983; 28:174.
- Hughes R. Drug-induced oesophageal injury. Br Med J 1979; 2:132.
- de Groen PC, Lubbe DF, Hirsch LJ, et al. Esophagitis associated with the use of alendronate. N Engl J Med 1996; 335:1016.
- Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348:1535.
- Lanza F, Sahba B, Schwartz H, et al. The upper GI safety and tolerability of oral alendronate at a dose of 70 milligrams once weekly: a placebo-controlled endoscopy study. Am J Gastroenterol 2002; 97:58.
- Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999; 282:1344.
- Taggart H, Bolognese MA, Lindsay R, et al. Upper gastrointestinal tract safety of risedronate: a pooled analysis of 9 clinical trials. Mayo Clin Proc 2002; 77:262.
- Liberman UA, Weiss SR, Bröll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995; 333:1437.
- Lanza FL, Hunt RH, Thomson AB, et al. Endoscopic comparison of esophageal and gastroduodenal effects of risedronate and alendronate in postmenopausal women. Gastroenterology 2000; 119:631.
- Zografos GN, Georgiadou D, Thomas D, et al. Drug-induced esophagitis. Dis Esophagus 2009; 22:633.
- Hey H, Jørgensen F, Sørensen K, et al. Oesophageal transit of six commonly used tablets and capsules. Br Med J (Clin Res Ed) 1982; 285:1717.
- SCHNEYER LH, PIGMAN W, HANAHAN L, GILMORE RW. Rate of flow of human parotid, sublingual, and submaxillary secretions during sleep. J Dent Res 1956; 35:109.
- Dent J, Dodds WJ, Friedman RH, et al. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 1980; 65:256.
- Hollis JB, Castell DO. Esophageal function in elderly man. A new look at "presbyesophagus". Ann Intern Med 1974; 80:371.
- Carlborg B, Densert O, Lindqvist C. Tetracycline induced esophageal ulcers. a clinical and experimental study. Laryngoscope 1983; 93:184.
- Olovson SG, Björkman JA, Ek L, Havu N. The ulcerogenic effect on the oesophagus of three beta-adrenoceptor antagonists, investigated in a new porcine oesophagus test model. Acta Pharmacol Toxicol (Copenh) 1983; 53:385.
- Carlborg B, Densert O. Esophageal lesions caused by orally administered drugs. An experimental study in the cat. Eur Surg Res 1980; 12:270.
- BOLEY SJ, ALLEN AC, SCHULTZ L, SCHWARTZ S. POTASSIUM-INDUCED LESIONS OF THE SMALL BOWEL. I. CLINICAL ASPECTS. JAMA 1965; 193:997.
- Bott S, Prakash C, McCallum RW. Medication-induced esophageal injury: survey of the literature. Am J Gastroenterol 1987; 82:758.
- Parfitt JR, Jayakumar S, Driman DK. Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes. Am J Surg Pathol 2008; 32:1367.
- Jaspersen D. Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management. Drug Saf 2000; 22:237.
- Henry JG, Shinner JJ, Martino JH, Cimino LE. Fatal esophageal and bronchial artery ulceration caused by solid potassium chloride. Pediatr Cardiol 1983; 4:251.
- Singh NP, Rizk JG. Oesophageal perforation following ingestion of over-the-counter ibuprofen capsules. J Laryngol Otol 2008; 122:864.
- Wong RK, Kikendall JW, Dachman AH. Quinaglute-induced esophagitis mimicking an esophageal mass. Ann Intern Med 1986; 105:62.
- Bonavina L, DeMeester TR, McChesney L, et al. Drug-induced esophageal strictures. Ann Surg 1987; 206:173.
- Abid S, Mumtaz K, Jafri W, et al. Pill-induced esophageal injury: endoscopic features and clinical outcomes. Endoscopy 2005; 37:740.