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Drug-induced esophagitis.

The esophagus, which connects the mouth to the stomach, can become inflamed because of stomach acid reflux, radiation damage, infection, or ingestion of caustic substances. Inflammation of the esophagus (esophagitis) can cause pain, difficulty in swallowing, ulcers, bleeding, strictures, or perforation.

A growing number of doctors are recognizing that standard doses of certain drugs can cause esophagitis. An article in the American Journal of Gastroenterology discussed a British study that reviewed 175 cases of drug-induced esophagitis.

The drugs most commonly involved were the antibiotics tetracycline and doxycycline, time-release potassium chloride, quinidine, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin, Feldene, and Indocin.

Although persons with preexisting esophageal strictures and motility disorders are at increased risk for drug-induced esophagitis, it may occur in the absence of esophageal disease.

Researchers found that up to 20 percent of the healthy volunteers in the Bradford Royal Infirmary study who took NSAIDs had esophagitis. Bleeding is sometimes seen in esophagitis patients, but heartburn, painful swallowing, and food sticking are the disease's most common symptoms. Many cases are caused by taking medication before bedtime without drinking enough water.

Endoscopy (visualizing the esophagus through an optical instrument inserted into the throat) is the preferred means of diagnosis. The most common site of esophagitis is the midway area, where the heart and the main artery, the arota, press on the esophagus; enough pressure may cause this area to narrow.

Treatment involves discontinuing the offending drug or switching to a liquid preparation. Antacids or other antiulcer mediation may also be used.

Those prone to the condition can help themselves by taking the medication while standing and washing it down with plenty of liquid. Bedridden patients should use liquid preparations of the drugs. Those who develop strictures may require repeated dilations.
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Publication:Medical Update
Date:Oct 1, 1993
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