Drug-Induced Esophageal Ulcer in Adolescent Population: Experience at a Single Medical Center in Central Taiwan

Background and Objectives: Drug-induced esophageal ulcer is caused by focal drug stimulation. It may occur in adults and children. Limited research is available in pediatric patients with drug-induced esophageal ulcer; therefore, we designed this study to determine the characteristics of this disease in this population. Materials and Methods: Thirty-two pediatric patients diagnosed with drug-induced esophageal ulcers from a hospital database of upper gastrointestinal tract endoscopies were included. After treatment, patients were followed for 2 months after upper gastrointestinal endoscopy. Results: Female patients were predominant (56.2%/43.8%). The mean age of patients was 15.6 years (median, 16 years; interquartile range, 2 years). Doxycycline was administered in most cases (56.3%); other drugs were dicloxacillin, amoxicillin, clindamycin, L-arginine, and nonsteroidal anti-inflammatory drugs. Doxycycline was associated with kissing ulcers. Esophageal ulcers induced by nonsteroidal anti-inflammatory drugs were more often associated with gastric or duodenal ulcers. The most common location was the middle-third of the esophagus (78.1%). Patients were treated with proton pump inhibitors, sucralfate, or H2-blockers. The mean duration for which symptoms lasted was 9.2 days. No esophageal stricture was found in 24 patients who were followed for 2 months after upper gastrointestinal endoscopy. Conclusions: The authors suggest informing patients to take medicine with enough water (approximately 100 mL) and enough time (15–30 min) before recumbency, especially high-risk drugs, such as doxycycline or nonsteroidal anti-inflammatory drugs.

Intramural Esophageal Hematoma Following Endoscopic Biopsy

Background: Intramural esophageal hematoma (IEH) is a rare form of esophageal injury, which may occur spontaneously, or be following esophageal dilatation, food impaction, improper swallowing of drug pills, thrombolysis therapy, or coagulopathy. However, it is uncommon that IEH could be induced by endoscopic biopsy.Case presentation: We report a 58-year-old male patient who developed chest pain and hematemesis after endoscopic biopsy. Fourteen days later, esophageal ulcer and hematoma disappeared by conservative management. After 3 months, gastroscopy showed old esophageal scar, and mucous healed completely.Conclusion: IEH is a rare complication of endoscopic biopsy, which is easily ignored. Moreover, It could be cured by conservative treatment.

Two cases of severe esophageal ulcer caused by chemotherapy for breast cancer after particle beam therapy for esophageal cancer

Background: Particle beam treatment for esophageal cancer can produce a better local therapeutic effect than can conventional radiotherapy. However, events that occur in the esophagus during or after the treatment of other cancers after that are unknown. Case summary: The first patient, a 64-year-old woman, had undergone heavy ion radiotherapy for esophageal cancer. Endoscopic submucosal dissection was performed for local residual tumor. Five years later, cancer was found in the right breast, and the patient underwent partial mastectomy and adjuvant chemotherapy. Six years after heavy ion radiotherapy, oral intake became difficult. A benign esophageal ulcer with circumferential stenosis was observed at the site of heavy particle irradiation. The second patient, a 63-year-old woman, had undergone proton therapy for esophageal cancer and photodynamic therapy for local residual tumor. Four years later, cancer was found in the left breast, and the patient underwent preoperative adjuvant chemotherapy, which reduced the size of the breast cancer. Oral intake became difficult 5 years after proton therapy. Endoscopy showed a benign esophageal ulcer with severe stenosis at the site of proton irradiation. Conclusion: After particle beam therapy for esophageal cancer, patients who undergo chemotherapy for other cancers may develop an esophageal ulcer. Keywords: Particle beam therapy; esophageal cancer; esophageal ulcer; breast cancer; chemotherapy

Kayexalate-Induced Esophageal Ulceration in a Patient with Decompensated Cirrhosis: A Review of the Literature

Hyperkalemia is one of the most common electrolyte abnormalities encountered in clinical practice. The treatment of hyperkalemia includes removal of excess potassium from the body using cation exchange resins, e.g., sodium polystyrene sulfonate (Kayexalate) is one of the most practiced modalities in clinical medicine. Colonic mucosal necrosis and perforation are the serious gastrointestinal side effects associated with sodium polystyrene sulfonate (SPS) use, which have been reported with or without concomitant use of sorbitol. However, the catastrophic bleeding esophageal ulcer has been rarely described in our literature search. Due to the risk of colonic necrosis, the FDA has issued a warning to avoid concomitant sorbitol use with Kayexalate. We present an individual with acute hematemesis due to bleeding esophageal ulcer immediately after treatment with Kayexalate therapy. Though the exact mechanism by which Kayexalate causes esophageal ulcer to be elucidated, nonetheless it is worthwhile to be vigilant about its potential adverse effects. Our case highlights the rare but certainly the life-threatening complication of Kayexalate therapy.

Amoxycillin-Clavulanic Acid-Induced Esophageal Ulcer: An Unusual Cause

Pill-induced esophagitis or esophageal ulcers are considered when patients have retrosternal chest pain or odynophagia following the ingestion of suspicious medications. Various drugs have been reported to induce esophageal ulcers. However, amoxycillin-clavulanic acid-induced esophagitis or esophageal ulcer has not been reported in literature. Hence, we report the case of a 30-year-old Thai male who presented with acute, severe odynophagia and retrosternal chest pain. He had a history of taking amoxycillin-clavulanic acid for 12 days. An esophagogastroduodenoscopy was performed and revealed geographic clean-based ulcers, with a kissing-ulcer appearance at the level of the mid-esophagus. A biopsy was taken and revealed inflamed granulation tissue and an ulcer with neither infection nor malignancy. Thus, the diagnosis of an amoxycillin-clavulanic acid-induced esophageal ulcer was made according to the clinicopathologic report.