Pill-induced esophagitis caused by ingesting excessive caffeine tablets

Abstract

A 19-year-old woman with suicidal thoughts consumed 24 anhydrous caffeine tablets and was admitted to our hospital. After being discharged from the hospital, her oral intake remained impaired because of retrosternal pain and she was readmitted. An upper gastrointestinal endoscopy revealed diffuse ulcers throughout the mid-to-lower esophagus; the patient was diagnosed with caffeine-induced esophagitis. She recovered soon after conservative treatment. A follow-up endoscopy performed 1 month after the patient was discharged showed that the ulcers had healed. This case highlights the risk of esophageal injuries after ingesting excessive caffeine tablets, which were sold as dietary supplement without a prescription. Our experience indicates that endoscopic surveillance is advisable to prevent severe complications if a patient presents with esophageal symptoms suggestive of chemical esophagitis.

Caffeine-Induced Severe Erosive Esophagitis

“…Here, we have presented a very rare case of severe erosive esophagitis due to caffeine overdose. To the best of our knowledge, only one case of esophageal injury secondary to an overdose of caffeine tablets has been reported in the English literature; three other cases of esophageal injury secondary to caffeine overdose have been reported in Japanese [ 6 ]. Miyata et al reported the case of a 19-year-old female who developed diffuse lower esophageal ulcers without any gastric ulcers or erosions following the consumption of 24 tablets of Estaron-mocha (SSP Co. Ltd., Chuo-Ku, Japan) amounting to 2.4 g of caffeine in an apparent suicide attempt [ 6 ].…”

“…Additionally, theophylline, a metabolite of caffeine, is known to induce gastroesophageal reflux when it is dissolved in the GI tract. Because both caffeine and theophylline are structurally and toxicologically similar, caffeine likely shares a similar mechanism of esophageal injury to theophylline [ 3 , 6 ]. Patient-related factors of pill-induced esophagitis, such as ingestion of pills with an inadequate volume of water, may also play a role in the GI toxicity of caffeine [ 7 ].…”

“…The most common endoscopic findings in patients with pill-induced esophagitis in order of decreasing frequency are esophageal mucosal erythema and erosion, ulcer with or without bleeding, coating with drug material, impacted pill fragments, stricture, and kissing ulcers [ 7 ]. These lesions are usually found in the mid-to-lower esophagus [ 6 , 7 ].…”

“…Although caffeine is generally considered to be safe in small-to-moderate amounts, caffeine overdose may result in varied clinical features, including gastrointestinal, neurologic, or cardiovascular symptoms [ 3 , 5 ]. While caffeine overdose frequently induces gastrointestinal symptoms, such as nausea, vomiting, and epigastric pain, the number of patients who experience significant esophageal injuries is extremely low [ 6 ]. Thus, the pathophysiologic and endoscopic features of caffeine-induced esophageal injury remain unclear.…”

Involvement of serotonergic pathways in gastric dysmotility induced by fat burning nutritional supplements in mice

“…But in humans, excessive amounts of caffeine (>2000 ​mg) can give rise to significant toxic effects, including tachycardia, severe hypertension, arrhythmia, seizures, nausea, vomiting, and even death. However, individuals sensitive to caffeine can exhibit adverse effects at lower doses ( Miyata et al., 2020 ; Duncanson et al., 2018 ).…”