Drug-induced esophagitis and helpful management for healthcare providers
Gastroenterology and Hepatology from Bed to Bench,
In recent decades, the number of cases developing drug-induced esophagitis (DIE) has reportedly been growing, which indicates the significance of detecting medicines capable of causing this adverse reaction. This study aims to provide an updated review on recent case reports of DIE, to evaluate the possible mechanism of this side effect, and to provide helpful management. Data was gathered through searches of three databases, namely PubMed, Medline, and Cochrane. Seven drug categories were evaluated: antibiotics, bisphosphonates, cardiovascular medicines, chemotherapeutic agents, non-steroidal anti-inflammatory drugs (NSAIDs), other medications, and supplements. According to the findings, retrosternal pain, heartburn, odynophagia, and dysphagia are typical symptoms of DIE, and in most cases, DIE is a self-limiting side effect which can be resolved by removing the causative agent and providing supportive therapy.
- Adverse drug reaction, Esophagus, Esophagitis, Medication, Supplement.
How to Cite
Szymanski T. Drug-Induced Esophagitis: What Pharmacists Need to Know. https://pharmacytimes.com/view/drug-inducedesophagitis-what-pharmacists-need-to-know (accessed November 27, 2021).
Antunes C, Sharma A. Esophagitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Emami MH, Haghighi M, Esmaeili A. Esophagitis caused by ciprofloxacin; A case report and review of the literature. Govaresh 2004;9: 272-76.
Zografos GN, Georgiadou D, Thomas D, Kaltsas G, Digalakis M. Drug-induced esophagitis. Dis Esophagus 2009;22:633–7.
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;32:1367–72.
Loft DE, Stubington S, Clark C, Rees WDW. Oesophageal ulcer caused by warfarin. Postgrad Med J 1989;65:258–9.
Gulsen MT, Buyukberber NM, Karaca M, Kadayifci A. Cyproterone acetate and ethinylestradiol-induced pill oesophagitis: a case report. Int J Clin Pract 2005;59:79–81.
Smith SJ, Lee AJ, Maddix DS, Chow AW. Pill-induced esophagitis caused by oral rifampin. Ann Pharmacother 1999;33:27–31.
Zezos P, Harel Z, Saibil F. Cloxacillin: A new cause of pill-induced esophagitis. Can J Gastroenterol Hepatol 2016;2016:2904256.
Abid S, Mumtaz K, Jafri W, Hamid S, Abbas Z, Shah HA, et al. Pill-induced esophageal injury: endoscopic features and clinical outcomes. Endoscopy 2005;37:740–4.
Mastracci L, Grillo F, Parente P, Unti E, Battista S, Spaggiari P, et al. Non gastro-esophageal reflux disease related esophagitis: an overview with a histologic diagnostic approach. Pathologica 2020;112:128–37.
Saleem F, Sharma A. Drug Induced Esophagitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Daǧ MS, Öztürk ZA, Akin I, Tutar E, Çikman Ö, Gülşen MT. Drug-induced esophageal ulcers: Case series and the review of the literature. Turk J Gastroenterol 2014;25:180–4.
Kim JW, Kim BG, Kim SH, Kim W, Lee KL, Byeon S, et al. Histomorphological and immunophenotypic features of pillinduced esophagitis. PLoS One 2015;10: e0128110.
Bott SJ, McCallum RW. Medication-induced oesophageal injury. Survey of the literature. Med Toxicol 1986;1:449–57.
Hachiya KA, Kobayashi RH, Antonson DL. Candida esophagitis following antibiotic usage. J Pediatr Infect Dis 1982;1:168–70.
Hongo M, Traube M, McCallum RW. Comparison of effects of nifedipine, propantheline bromide, and the combination on esophageal motor function in normal volunteers. Dig Dis Sci 1984;29:300–4.
Collins FJ, Matthews HR, Baker SE, Strakova JM. Druginduced oesophageal injury. Br Med J 1979;1:1673–6.
Kadayifci A, Gulsen MT, Koruk M, Savas MC. Doxycyclineinduced pill esophagitis. Dis Esophagus 2004;17:168–71.
Xiao SY, Zhao L, Hart J, Semrad CE. Gastric mucosal necrosis with vascular degeneration induced by doxycycline. Am J Surg Pathol 2013;37:259–63.
Shih AR, Lauwers GY, Mattia A, Schaefer EAK, Misdraji J. Vascular Injury Characterizes Doxycycline-induced Upper Gastrointestinal Tract Mucosal Injury. Am J Surg Pathol 2017;41:374–81.
Bestari MB, Agustanti N, Abdurachman SA. Clindamycin-Induced Esophageal Injury: Is It an Underdiagnosed Entity? Clin Med Insights Case Rep 2019;12.
Stanić Benić M, Karlović K, Čubranić A. Clindamycininduced necrotising oesophagitis. Postgrad Med J 2016;92:741.
Royero Gutiérrez HA. Ulceras esofágicas inducidas por ciprofloxacino. Acta Médica Colombiana 2020;45. [In Spanish].
Drug-induced esophageal injuries--an overview. Adverse effects of felodipine and ciprofloxacin observed during 2 years. Lakartidningen 1990;87:2368–9.
Santos VM, Carneiro MV, Cruz LR, Paixão GTG. Druginduced acute esophageal lesions and use of ciprofloxacin. An Sist Sanit Navar 2012;35:127–31.
Majalekar PP, Shirote PJ. Fluoroquinolones: Blessings or curses. Curr Drug Targets 2020;21:1354-70.
Kaewdech A, Pattarapuntakul T, Sripongpun P. Amoxycillinclavulanic acid-induced esophageal ulcer: An unusual cause. Case Rep Gastroenterol 2020;14:472–6.
de Groen PC, Lubbe DF, Hirsch LJ, Daifotis A, Stephenson W, Freedholm D, et al. Esophagitis associated with the use of alendronate. N Engl J Med 1996;335:1016–21.
Petersen KU, Jaspersen D. Medication-induced oesophageal disorders. Expert Opin Drug Saf 2003;2:495–507.
Drug-induced esophagitis. JAMA 1985;254:508.
Ryan JM, Kelsey P, Ryan BM, Mueller PR. Alendronateinduced esophagitis: case report of a recently recognized form of severe esophagitis with esophageal stricture--radiographic features. Radiology 1998;206:389–91.
Mungan Z, Şimşek BP. Which drugs are risk factors for the development of gastroesophageal reflux disease? Turk J Gastroenterol 2017;28:38–43.
Miyamoto M, Haruma K, Kuwabara M, Nagano M, Okamoto T, Tanaka M. High incidence of newly-developed
gastroesophageal reflux disease in the Japanese community: A 6-year follow-up study. J Gastroenterol Hepatol 2008;23:393–7.
Kim SH, Jeong JB, Kim JW, Koh SJ, Kim BG, Lee KL, et al. Clinical and endoscopic characteristics of drug-induced esophagitis. World J Gastroenterol 2014;20:10994–9.
Hughes J, Lockhart J, Joyce A. Do calcium antagonists contribute to gastro-oesophageal reflux disease and concomitant noncardiac chest pain? Br J Clin Pharmacol 2007;64:83–9.
Okada M, Okada K. Exfoliative esophagitis and esophageal ulcer induced by dabigatran. Endoscopy 2012;44: E23-4.
Zhang N, Liu XS, Li G, Liu T. Dabigatran-induced esophagitis: A frequently overlooked adverse effect. Int J Cardiol 2016;212:358–9.
Zhou Y, Dai Y, Lu L, Fu Z. Dabigatran-induced esophagitis: A case report. Medicine 2020;99:19890.
Shibagaki K, Taniguchi H, Goto D, Kobayashi K, Kinoshita Y. Dabigatran-induced asymptomatic esophageal mucosal injury. Gastrointest Endosc 2016;83:472–4.
Bytzer P, Connolly SJ, Yang S, Ezekowitz M, Formella S, Reilly PA, et al. Analysis of upper gastrointestinal adverse events among patients given dabigatran in the RE-LY trial. Clin Gastroenterol Hepatol 2013;11:246-252.5.
Kono Y, Miyahara K, Nakagawa M. A case of esophagitis induced by apixaban. J Gastrointestin Liver Dis 2020;29:465–76.
Nagata K, Akazawa Y. Exfoliative esophagitis induced by sunitinib. Mayo Clin Proc 2019;94:557–8.
Gayam S, Anumandla A. A rare case of sunitinib-induced exfoliative esophagitis. ACG Case Rep J 2016;3:155.
Ma H, Chen M, Liu J, Li Y, Li J. Serious stomatitis and esophagitis: a peculiar mucous reaction induced by pegylated liposomal doxorubicin. An Bras Dermatol 2015;90:209.
Batres LA, Gabriel CA, Tsou VM. Methotrexate-induced esophagitis in a child with Crohn disease. J Pediatr Gastroenterol Nutr 2003;37:514–6.
Kooshkaki O, Derakhshani A, Hosseinkhani N, Torabi M, Safaei S, Brunetti O, et al. Combination of ipilimumab and nivolumab in cancers: From clinical practice to ongoing clinical trials. Int J Mol Sci 2020;21:1–27.
Endo R, Nakamura Y, Ishizuki S, Ishitsuka Y, Watanabe R, Okiyama N, et al. Ulcerative esophagitis associated with combined nivolumab and ipilimumab therapy. J Dermatol 2020;47:299–300.
Heller SR, Fellows IW, Ogilvie AL, Atkinson M. Nonsteroidal anti-inflammatory drugs and benign oesophageal stricture. Br Med J (Clin Res Ed) 1982;285:167–8.
Semble EL, Wu WC, Castell DO. Nonsteroidal antiinflammatory drugs and esophageal injury. Semin Arthritis Rheum 1989;19:99–109.
Wilkins WE, Ridley MG, Pozniak AL. Benign stricture of the oesophagus: Role of non-steroidal anti-inflammatory drugs. Gut 1984;25:478–80.
Lanas A, Boers M, Nuevo J. Gastrointestinal events in at-risk patients starting non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatic diseases: the evidence study of European routine practice. Ann Rheum Dis 2015;74:675–81.
Yasuda H, Yamada M, Endo Y, Inoue K, Yoshiba M. Acute necrotizing esophagitis: role of nonsteroidal anti-inflammatory drugs. J Gastroenterol 2006;41:193–7.
Javelot H, Michel B, Kumar D, Audibert B. Clozapineinduced esophagitis at therapeutic dose: A case report. Braz J Psychiatry 2016;38:176–7.
Edwards P, Turner J, Gold J, Cooper DA. Esophageal ulceration induced by zidovudine. Ann Intern Med 1990;112:65–6.
Indorf AS, Pegram PS. Esophageal ulceration related to zalcitabine (ddC). Ann Intern Med 1992;117:133–4.
de la Parra PRB, González-Cruz M, Ferreiro-Marin A, Casaubón-Garcín PR. L-arginine-induced esophagitis, Report of six cases. Bol Med Hosp Infant Mex 2020;77:38–41.
Jaspersen D. Drug-induced oesophageal disorders: Pathogenesis, incidence, prevention and management. Drug Saf 2000;22:237–49.
st. Clair Health. Esophagitis. Available from: https://stclair.org/services/mayo-clinic-health-information/diseasesand-conditions/CON-20312402/ (accessed December 17, 2021).
de Groen PC, Lubbe DF, Hirsch LJ, Daifotis A, Stephenson W, Freedholm D, et al. Esophagitis associated with the use of alendronate. N Engl J Med 2009;335:1016–21.
Bott SJ, McCallum RW. Medication-induced oesophageal injury: Survey of the literature. Med Toxicol 1986;1:449–57.
Boyce J. Drug-induced esophageal damage: Diseases of medical progress. Gastrointest Endosc 1998;47:547–50.
Perkins AC, Wilson CG, Frier M, Vincent RM, Blackshaw PE, Dansereau RJ, et al. Esophageal transit of risedronate cellulosecoated tablet and gelatin capsule formulations. Int J Pharm 1999;186:169–75.
Marvola M, Rajaniemi M, Marttila E, Vahervuo K, Sothmann A. Effect of dosage form and formulation factors on the adherence of drugs to the esophagus. J Pharm Sci 1983;72:1034–6.
Kikendall JW, Friedman AC, Oyewole MA, Fleischer D, Johnson LF. Pill-induced esophageal injury. Case reports and review of the medical literature. Dig Dis Sci 1983;28:174–82.
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