Dabigatran-induced esophagitis

Abstract

Rationale: Dabigatran is an anticoagulant medication that has been widely used to prevent strokes caused by atrial fibrillation, deep vein thrombosis, and pulmonary embolism. However, the potential adverse effect of dabigatran of gastrointestinal mucosal injury is often neglected, and even induces esophagitis. Patient concerns: A 77-year-old woman was admitted to the hospital with symptoms of progressive retrosternal pain, upper abdominal discomfort, and dysphagia. Diagnosis: Esophagogastroduodenoscopy showed longitudinal sloughing mucosal casts in the distal esophagus. Histological examination showed squamous epithelium with neutrophil infiltration, partial epithelial degeneration, and Helicobacter pylori. Based on a literature review, medical history, and imaging examination, the patient was diagnosed with dabigatran-induced esophagitis. Interventions: The patient recovered with standard H. pylori eradication therapy and proton pump inhibitor without discontinuing dabigatran. Outcomes: After 2 weeks, the retrosternal pain and dysphagia were relieved and upper abdominal discomfort was attenuated. Lessons: Our case highlights the importance of physicians’ awareness of the clinical and endoscopic characteristics of dabigatran-induced esophagitis and the importance of H. pylori-associated tests and eradication if necessary for patients with long-term dabigatran treatment.

Comparison of the efficacy and safety between rivaroxaban and dabigatran in the treatment of acute portal vein thrombosis in cirrhosis

“…Note that no significant association was found between platelet count or Child–Pugh Grade and major bleeding. However, some case reports have found that dabigatran is associated with exfoliative esophagitis and esophageal ulcer [ 46 – 48 ]. Toyo et al displayed that 19 (20.9%) of the 91 patients receiving dabigatran showed esophagitis in a retrospective study [ 49 ].…”

Esophageal Injury Due to Long-term Use of Dabigatran

“… 6 Previous reports showed that DIE usually develops shortly or approximately one year after dabigatran initiation. 2 , 3 This is an extremely rare case in which DIE became apparent eight years after its commencement. If a patient taking dabigatran presents with chest or abdominal symptoms, clinicians should consider that DIE may be the cause regardless of its start date.…”

“… 2 DIE may be asymptomatic or present along with one or more of the following symptoms: chest pain, dysphagia, epigastralgia, and heartburn. 3 DIE presents with the characteristic endoscopic finding of longitudinal sloughing of the epithelium in the middle to the distal esophagus, which is the key to its diagnosis. 2 Treatment options include instructing patients how to take dabigatran to avoid lodging in the esophagus (i.e., taking dabigatran with plenty of water and maintaining an upright position for 30 minutes or more after taking it) and switching to another DOAC.…”

Prevalence of Dabigatran-Associated Esophagitis on Upper Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis

“…Dabigatran-associated esophagitis (DAE) has been reported increasingly recently in the literature with conflicting findings. 1–5 Toya et al 1 reported that nearly 20% of patients who ingested dabigatran had evidence of esophagitis on endoscopy. On the other hand, Tajima et al 2 reported that DAE prevalence was nearly 9%.…”