[Esophagitis due to alendronate. Report of two cases]

Two patients affected by esophagitis arised during therapy with alendronate, an aminobiphosphonate often used today in the treatment of the postmenopausal osteoporosis are presented. Two osteoporotic women, without gastroenterological past history, developed dysphagia, odynophagia and retrosternal pain shortly after starting therapy. Endoscopy demonstrated ulcerative esophagitis affecting circumferentially the distal portion of the esophagus. Biopsies showed aspecific inflammatory changes and no sign of fungi or viral inclusions. The discontinuation of alendronate, with additional use of a protonic pump inhibitor and sucralfate, led to complete recovery and normalization of endoscopic findings. In both patients esophagitis was associated with incorrect intake of alendronate, resulting in prolonged mucosal exposure to the noxious effect of the drug. In order to prevent it the necessity is stressed to inform adequately patients on how to take the drug correctly and to select carefully the cases to treat, excluding those having reflux symptoms or other esophageal disorders that would facilitate the drug induced damage.