Clindamycin-Induced Esophageal Injury: Is It an Underdiagnosed Entity?

Abstract

There are increased reports of pill-induced esophagitis in the past 2 decades, with almost 100 different substances identified as the cause for more than 700 cases, and the overall incidence is estimated to be 0.004% per year. Antibiotics are one of the major contributors for these cases, especially tetracycline and doxycycline; other major contributors are bisphosphonates, nonsteroidal anti-inflammatory drugs, and iron pills. Clindamycin is commonly prescribed by physicians, yet side effect in the form of esophagitis is uncommon and mostly documented in case report. It is possible that these cases are mostly unnoticed due to initial consideration of common and more serious problems. Thus, patients may be assumed to be having a severe episode of acid reflux, and it is not routinely reported or recognized. In this case series, we presented 8 patients with clindamycin-induced esophagitis. The initial presentation of all patients was odynophagia, which appeared within the first day of taking the antibiotic. All patients were subjected to endoscopic examination and ulcer was found in all cases, in the form of localized solitary or multiple ulcers with sharply defined borders. Patients were treated with proton pump inhibitor and sucralfate, and the symptoms subside within 1 week. Patient education regarding the proper way of ingesting drug seems to be the key factor in the prevention of pill-induced esophagitis. The prevention of esophagitis is even more important with antibiotics as adverse effect would decrease the patient compliance in completing the regimen and would ultimately increase antibiotic resistance.

Clinical and endoscopic features of pill-induced esophagitis

“…According to the literature, pill-induced esophagitis is more frequently observed in the females than in males, this might be attributable to the fact that women consume more culprit medications than men. 9 Female gender dominance was also observed in our study, where 56 (62.2%) patients were females. Pill, patient, and esophageal motility disorders related factors are responsible in the development of pill-induced esophagitis.…”

Non gastro-esophageal reflux disease related esophagitis: an overview with a histologic diagnostic approach

“…The term pill-induced esophagitis refers to esophageal injury caused by almost 100 different types of substances ingested in form of pills. Antibiotics are one of the major contributors, especially tetracycline and doxycycline; other major contributors are biphosphonates, non-steroidal anti-inflammatory drugs and iron pills 6 . Injuries occur when caustic medicinal pills dissolve in the esophagus rather than passing rapidly into the stomach 7 ; usually this occurs for larger pills and/or in correspondence of lumen reduction or strictures which make swallowing more difficult 8 .…”

Amoxycillin-Clavulanic Acid-Induced Esophageal Ulcer: An Unusual Cause

“…A variety of medications including antibiotics, non-steroidal anti-inflammatory drugs, bisphosphonates, ascorbic acid, potassium chloride, ferrous sulfate, acetaminophen, warfarin, and chemotherapeutic regimens have been reported as causing esophagitis or ulcers [ 3 , 4 , 5 ]. Antibiotics are the most common etiology, and well-recognized antibiotics that can cause pill-induced esophagitis/ulcer are: doxycycline [ 6 ], clindamycin [ 7 ], cloxacillin [ 8 ], or rifampicin [ 9 ].…”