Medication-induced esophageal injury: survey of the literature

A review of the 127 cases of drug-induced esophagitis reported since 1970 indicates that commonly used medications may be a source of esophageal injury. Retrosternal pain, odynophagia, and dysphagia were the most commonly reported symptoms and most cases were self-limited with 7 to 10 days of symptomatic therapy. Occasionally, severe odynophagia or dysphagia necessitated hospitalization. Emepronium bromide, tetracycline, and its derivatives, potassium chloride, and quinidine accounted for 89% of the reported cases; the remaining 11% were caused by 14 other medications. Serious sequelae, including death, have been linked to potassium-induced esophageal injury. With other medications, however, serious complications were rare. The diagnostic study of choice for suspected medication-induced esophageal injury is endoscopy, although air contrast barium swallow may often detect subtle mucosal abnormalities. In uncomplicated cases the history alone may be sufficient to make the diagnosis. Concurrent ingestion of adequate amounts of fluid and avoidance of unnecessary bedtime medications may help to prevent medication-induced esophageal injury.