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Pill -Induced Erosive Esophagitis in Children
Madalina Adriana Bordea1, Alexandru Pirvan2, Costica Sarban1
1Pediatrics Clinics II. Emergency Hospital for Children, Cluj-Napoca, Romania.
Insights
Pill-induced esophagitis is rare in children but should be considered. Taking medications like NSAIDs or antibiotics with little water can cause esophageal ulcers, which resolve with treatment.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Pathology
- Pharmacology
Background:
- Pill-induced esophagitis is well-documented in adults but infrequently reported in pediatric populations.
- This condition involves esophageal injury caused by direct contact with medications.
- Understanding its presentation in children is crucial for accurate diagnosis and management.
Purpose of the Study:
- To describe the endoscopic findings associated with pill-induced esophagitis in children.
- To identify common medications implicated in pediatric cases.
- To outline effective prevention and treatment strategies for this condition.
Main Methods:
- A retrospective analysis of 26 pediatric patients diagnosed with drug-induced esophageal ulcerations over a 4-year period.
- Diagnosis was confirmed via endoscopy.
- Treatment involved proton-pump inhibitors and prokinetics.
Main Results:
- Esophageal ulcers were commonly located in the mid-esophagus.
- Key symptoms included odynophagia, retrosternal pain, and dysphagia.
- Implicated medications included NSAIDs, doxycycline, and ferrous sulfate, often taken with minimal water at bedtime.
- Symptoms resolved within one week of antireflux therapy.
Conclusions:
- Pill-induced esophagitis should be considered in pediatric patients presenting with chest pain and dysphagia, especially those taking oral medications.
- Physicians should educate patients on proper medication intake, emphasizing sufficient water and upright posture.
- Early suspicion and appropriate management can lead to rapid symptom resolution.
Aims:
Pill-induced esophagitis has been recognized in adults, but rarely in children. The aim of this article is to discuss endoscopic features, drugs implicated, prevention and treatment in pill-induced esophagitis in children.
Patients And Methods:
Over a period of 4 years, 26 patients presented at our clinic with drug-induced esophageal ulcerations. All patients were diagnosed by means of endoscopy and treated with proton-pump inhibitors and prokinetics. The mean age of the children was 10.76 years.
Results:
The ulcers were frequently located at the mid-esophagus. Odynophagea, retrosternal pain and dysphagia were the most common presenting symptoms. All children took pills (non-steroidal anti-inflammatory drugs, antibiotics - Doxycycline and ferrous sulfate) with little water and at bed time. The mean elapse between the drug intake and endoscopy was 4.96 days. The symptoms resolved within a maximum of one week of antireflux therapy.
Conclusions:
In pediatric cases treated by tablets or capsules, the possibility of medication-induced esophagitis should always be considered. The drug-induced esophagitis should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough water and in the upright position.
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