Bisphosphonate-induced Esophagitis Dissecans Superficialis: A Rare Case Report

Area of Science:

• Gastroenterology
• Pharmacology
• Pathology

Background:

• Esophagitis dissecans superficialis (EDS), or sloughing esophagitis, is an uncommon benign esophageal condition.
• It is frequently underdiagnosed due to its rarity and nonspecific symptoms.
• Medication-induced mucosal injury, particularly from bisphosphonates used for osteoporosis, is a significant cause of EDS.

Purpose of the Study:

• To report a case of EDS secondary to bisphosphonate use.
• To highlight the importance of considering drug-induced esophageal injury in refractory cases.
• To emphasize the diagnostic and therapeutic implications of bisphosphonate-induced EDS.

Main Methods:

• A case report of a 66-year-old woman with persistent retrosternal pain.
• Diagnostic procedures included upper gastrointestinal endoscopy and histopathological analysis.
• Treatment involved discontinuation of bisphosphonate and continuation of proton-pump inhibitor therapy.

Main Results:

• Endoscopy revealed extensive sloughing of esophageal mucosa with superficial ulceration.
• Histopathology confirmed superficial mucosal necrosis consistent with EDS.
• Discontinuation of bisphosphonate resulted in complete symptom resolution within two weeks.

Conclusions:

• Bisphosphonate therapy can cause significant esophageal mucosal damage, leading to EDS.
• Clinicians should suspect bisphosphonate-induced EDS in patients with refractory symptoms unresponsive to acid suppression.
• Early recognition and withdrawal of the offending bisphosphonate agent are crucial for rapid clinical and endoscopic improvement.