Related Experiment Videos
Prospective evaluation of medication-induced esophageal injury and its relation to esophageal function
J F Alvares1, S G Kulkarni, S J Bhatia
1Department of Gastroenterology, T N Medical College, Mumbai.
Background:
Few prospective studies are available on the incidence of medication-induced esophageal injury (MIEI).
Aims:
To prospectively study the occurrence of MIEI with indomethacin and doxycycline and the predictive factors for its development.
Methods:
In an operator-blinded study, 51 patients (age 16-65 y) requiring indomethacin (n = 24) or doxycycline (27) underwent symptom evaluation, endoscopy and scintigraphy before and after 7 days of therapy. MIEI was defined as de novo occurrence or worsening of pre-existing esophagitis or development of esophageal ulcer.
Results:
Pre-therapy endoscopy was normal in 32 patients and revealed esophagitis in 19 (grade I--11, grade II--8). Post-therapy, 16 patients developed esophageal symptoms, which appeared earlier with doxycycline (2.0 [0.8] vs 4.1 [1.7] days, p = 0.016). MIEI developed in 23 patients--de novo esophagitis in 16, worsening of esophagitis in 6; 5 patients developed ulcer. Seven of 12 patients with hiatus hernia developed MIEI. Presence of pre-therapy gastroesophageal reflux disease did not predict MIEI. There was no difference in pre- or post-therapy transit values between patients with and without MIEI; patients who developed ulcers had significantly slower esophageal transit (p < 0.05). There was no difference in esophageal transit or occurrence of MIEI between patients who received indomethacin or doxycycline; however, 5 of 8 patients with hiatus hernia who received doxycycline developed MIEI (p = 0.02; relative risk 3.96 [CI 1.2-12.7]).
Conclusions:
40% of patients receiving doxycycline or indomethacin developed MIEI; 10% developed ulcers. Hiatus hernia increased the risk for MIEI.
Insights
Medication-induced esophageal injury (MIEI) occurred in 40% of patients taking indomethacin or doxycycline, with hiatus hernia increasing risk. Ulcers developed in 10% of patients, linked to slower esophageal transit.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Prospective studies on medication-induced esophageal injury (MIEI) incidence are limited.
- Understanding MIEI risk factors is crucial for patient safety.
Purpose of the Study:
- To prospectively investigate MIEI occurrence with indomethacin and doxycycline.
- To identify predictive factors for MIEI development.
Main Methods:
- An operator-blinded study involving 51 patients (age 16-65) treated with indomethacin or doxycycline.
- Patients underwent symptom evaluation, endoscopy, and scintigraphy before and after 7 days of therapy.
- MIEI was defined as new or worsening esophagitis or esophageal ulcer.
Main Results:
- MIEI developed in 40% of patients; 10% developed esophageal ulcers.
- Esophageal symptoms appeared sooner with doxycycline.
- Hiatus hernia was a significant risk factor for MIEI, particularly with doxycycline.
Conclusions:
- Indomethacin and doxycycline can cause MIEI in a substantial proportion of patients.
- Hiatus hernia increases the risk of medication-induced esophageal injury.
- Slower esophageal transit may be associated with ulcer development.