Drug-Induced Esophagitis

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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 Aortic arch, left main bronchus, retrocardiac

• Findings on esophagram (double contrast)

image Solitary or localized cluster of tiny ulcers distributed circumferentially on normal background mucosa
image Punctate, linear, stellate, serpiginous, or ovoid; collections of barium on esophageal surface
image Longer areas of ulceration with potassium chloride, quinidine, biphosphonates, and in patients with cardiomegaly
image Mass effect surrounding ulcer due to edema and inflammation; can mimic ulcerated carcinoma
• Superficial ulceration

image Giant, flat ulcers are uncommonly seen

TOP DIFFERENTIAL DIAGNOSES

• Reflux esophagitis
• Viral esophagitis
• Esophageal carcinoma
• Barrett esophagus

CLINICAL ISSUES

• Patient wakes up with severe odynophagia in morning after taking medications at bedtime with insufficient water

image Usually resolves spontaneously
• Main classes of medications at fault

image Antibiotics (especially tetracyclines)
image Anti-inflammatories (aspirin, NSAIDS, etc.)
image “Cardiac” drugs (quinidine, potassium chloride, etc.)
image Biphosphonates (to prevent bone loss; can cause severe, longer segment esophageal ulceration)
image
(Left) Graphic shows medication pills stuck at the level of the aortic arch with focal spasm and ulceration image.

image
(Right) Esophagram shows broad, shallow ulceration image at the aortic arch level. The patient had odynophagia and recent tetracycline ingestion, and the symptoms resolved spontaneously. Physiological points of esophageal narrowing, such as at the aortic arch and the retrocardiac portion of the esophagus, are the most commonly cited for pill-induced esophagitis.
image
(Left) Double-contrast barium esophagram in a 50-year-old woman with odynophagia while taking tetracycline shows multiple ulcerations image and a subtle stricture or spasm of the distal esophagus.

image
(Right) This 70-year-old woman with cardiac disease awoke with severe odynophagia the morning after taking her quinidine at bedtime. Barium esophagram demonstrates a long stricture or focal spasm image from the thoracic inlet to the aortic arch without definite ulceration.
image
Double-contrast esophagram shows a cluster of ulcers in the distal esophagus.

image
In this elderly patient with heart disease taking quinidine and other medications, stricture and ulceration are seen at the thoracic inlet; an unusual site for drug-induced esophagitis.