Medication-induced esophageal injury: Clinical analysis of 28 cases

Twenty-eight cases of medication-induced esophageal injury (MIEI), seen over a two-year period from October 1989 to September 1991, in Ghang Gung Memorial Hospital, were studied. These included 13 males and 15 females, with a mean age of 41.8 years (range 23 to 79 years). The mean age of the 18 (64%) cases resulting from antibiotics was significantly younger then the 10 (36%) cases caused by non antibiotics (35 vs. 53.9 years, P < 0.01). The presenting symptoms included odynophegia (50%), dysphagia (36%), epigastric pain (32%), retrosternal pain (18%), upper gastrointestinal bleeding (11%), chest pain (11%), heartburn (11%), and an esophageal foreign body sensation (11%). The ingested medications included ketoconazole, clindamycin, cephalexin, tetracycline, propantheline bromide, aspirin, glipizide, mefenamic acid, tenormin, and 13 unknown medications (9 antibiotics and 4 analgesics). Most patients took the medications for an upper respiratory tract infection (n = 8), pelvic inflammatory disease (n = 7), or pain due to various causes (n = 5). Endoscopy discovered most ulcers in the upper two-thirds of the esophegus (18/28), and in half of the cases there were multiple ulcers. After cessation of the offending drugs and medical treatment, symptoms generally subsided within 1 week (22/28). Endoscopy follow-up at 1 and 3 weeks in 2 of our cases revealed complete healing of the ulcers.