Esophagitis dissecans superficialis associated with bisphosphonates

Hokama, Akira; Ihama, Yasushi; Nakamoto, Manabu; Kinjo, Nagisa; Kinjo, Fukunori; Fujita, Jiro

doi:10.1055/s-2006-945146

Cited by 34 publications

(23 citation statements)

References 2 publications

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“…[18][19][20] Interestingly, one of the two patients reported in the literature with esophagitis dissecans superficialis due to bisphosphonates was a 90-yearold woman who was bedridden and had been taking alendronate while in bed. 20 Esophagitis dissecans superficialis has also been observed in patients with strictures, severe infectious esophagitis, renal failure, and in association with various autoimmune bullous dermatoses, including pemphigus vulgaris and bullous pemphigoid, both of which have cleavage planes that are occasionally seen histologically in esophagitis dissecans superficialis.…”

Section: Discussionmentioning

confidence: 99%

“…13,17 A wide age range with equal sex distribution is reported in the literature, and cases have been reported in healthy young adults, who often present with dysphagia or odynophagia or who rarely may vomit a membranous cast. [13][14][15][16][17][18][19][20][21] Therefore, esophagitis dissecans superficialis shares with sloughing esophagitis the facts that both of them are intraepithelial abnormalities, both may be drug-related, and both may have endoscopic membranes. However, esophagitis dissecans superficialis seems, in some cases, to have associations that are not observed in sloughing esophagitis, and often has different histologic patterns and different clinical presentations.…”

Section: Discussionmentioning

confidence: 99%

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Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

2012

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Sloughing esophagitis is characterized by superficial necrotic squamous epithelium and endoscopic plaques or membranes. According to abstract reports SE affects older, debilitated patients on multiple medications. This study seeks to evaluate the clinical findings in patients with SE. Thirty-one patients with necrotic superficial squamous epithelium, with endoscopic white plaques or membranes, but without fungi, were compared with 34 patients having esophageal biopsies done for any purpose other than Barrett's surveillance. Sloughing esophagits patients were older than controls (56 vs 43.5 years) and were more likely to be taking five or more medications (77 vs 32%), especially central nervous system depressants (65 vs 32%) and medications associated with esophageal injury (55 vs 18%). In 69% the plaques were in the distal and/or mid-esophagus; 23% involved the entire esophagus; 8% were limited to the proximal esophagus. There was no correlation between medication history and site. Sloughing esophagitis patients were likely to be debilitated based on evidence such as being on home oxygen, in nursing homes, bedridden, hospitalized, or malnourished, having metastatic cancer, organ transplantation, and/or being immunosuppressed. Sloughing esophagitis patients were more likely to have died since the biopsy (23 vs 3%), have peptic ulcer disease (55 vs 24%), or renal insufficiency (16% vs none), but no more likely to have dysmotility disorders, irritable bowel disease, or atherosclerosis. SE patients were less likely to have gastroesophageal reflux disease (45 vs 74%). No specific cause for sloughing esophagitis was identified, but the association with multiple drugs and conditions that may lead to esophageal stasis and/or injury, suggest that this is a local, perhaps contact injury, rather than an ischemic injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

2012

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“…No particular cause could be identified for the condition but the authors concluded stasis and contact injury due to multiple medications may lead to the condition. Other case reports have described associations with medications, typically bisphosphonates [8] and post sclerotherapy of varices [9]. One of the four patients we describe here was over 60 year's age and one was female.…”

Section: Discussionmentioning

confidence: 59%

Esophagitis Dessicans Superficialis - Impressive Endoscopic Appearance of a Benign Condition

Mohiuddin¹

2017

BJSTR

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Cases Case 1 Figure 1:15-year-old male diagnosed with cerebral palsy and seizure disorder was referred for dysphasia to solid food progressing over 3 months to dysphasia to both solids and liquids. His medications included Lamotrigine for his Seizure disorder, Supplemental Iron for Iron deficiency anemia and Lansoprazole once daily for reflux disease. Esophagus gastro duodenoscopy (EGD) showed that the lower third of the esophagus has yellowish plaque like material ( Figure 1a) which on removal revealed sloughed and friable mucosa ( Figure 1b) and a partial stricture at the distal esophagus. A 9 mm scope could not pass the distal esophagus due to a partial stricture but a 5 mm slim scope was passed. Histopathology showed esophageal mucosa with extensive ulceration and granulation tissue. There were no viral inclusions, granuloma, dysplasia or malignancy.Staining for Periodic Acid Schiff (PAS), Herpes Simplex Virus (HSV) and Cytomegalovirus (CMV) was negative. He was prescribed twice daily dose of Proton pump inhibitor therapy (PPI) for 2 months. Upon clinical improvement the patient was prescribed once daily PPI therapy for the next 4 months. Repeat OGD after 6 months of PPI therapy showed a normal and completely healed esophageal mucosa with no evidence of the previously noted partial stricture. (Figure 1c). Case 235-year-old male known to have colon cancer status post total hemicolectomy and on chemotherapy was referred due to persistent dysphasia and recurrent vomiting. Medication history was significant for chemotherapy regimen Folfiri Cetuximab with his last cycle received two weeks back. OGD revealed sloughed lower esophageal mucosa with whitish cast like material adherent to it (Figure 2a). After flushing the casts with water jet the underlying mucosa showed ulcerations and sloughing ( Figure 2b). Histopathology revealed ulceration and inflammation with no granuloma, metaplasia or dysplasia. Stains for CMV and HSV were negative. His chemotherapy was continued and a prescription of twice daily PPI therapy was added. After 4 months the patient had a repeat OGD that showed complete healing and normal esophageal mucosa except for a small hiatus hernia (Figure 2c). The dysphasia and vomiting subsided with mild residual reflux symptoms at 6 months. AbstractEsophagitis Dessicans Superficialis (EDS) refers to a rare and unique lesion of the esophagus characterized by sloughing of esophageal mucosa. A benign condition, it is thought to be a mucosal reaction to various types of insults or a mucosal allergic response. Various clinical presentations, endoscopic appearances and associations with systemic diseases have been described in literature. We report 4 consecutive cases of this rare condition in our endoscopy practice with varying endoscopic characteristics and present a literature review of EDS.

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“…[2], la dysphagie était le principal signe révélateur. Parfois, on peut avoir une simple dyspepsie ou une odynophagie [4]. Dans nos deux premières observations, la dysphagie était le signe révélateur alors que chez notre dernière patiente la découverte était fortuite.…”

Section: Observation N Ounclassified

“…L'oesophagite disséquante peut être primitive ou secondaire à certaines affections dermatologiques (lichen plan, pemphigus vulgaire, pemphigoïde bulleuse), à des causes traumatiques (syndrome de Mallory-Weiss, sonde nasogastrique), médicamenteuses (biphosphonate) [4], à un reflux gastro-oesophagien ou d'origine infectieuse [2][3][4][5]. De rares cas ont été décrits associés à une insuffisance rénale chronique [6] ou secondaires à une sclérose ou à une ligature de varices oesophagiennes [1].…”

Section: Observation N Ounclassified

Les œsophagites disséquantes: à propos de trois observations

Mellouki

Benajah

Aqodad

et al. 2010

J Afr Hepato Gastroenterol

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Esophagitis dissecans superficialis associated with bisphosphonates

Abstract: Esophageal injury has been associated with various medications. Here we de− scribe a case of esophagitis dissecans su− perficialis associated with bisphospho− nates.

Cited by 34 publications

References 2 publications

Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

Esophagitis Dessicans Superficialis - Impressive Endoscopic Appearance of a Benign Condition

Les œsophagites disséquantes: à propos de trois observations

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