Drug-induced oesophageal injury

Direct oesophageal injury can occur as an adverse effect of drugs. It has been reported with a number of drugs, including oral bisphosphonates, doxycycline, slow-release potassium chloride, nonsteroidal anti-inflammatory drugs (including aspirin) and iron supplementsSaleem, 2021.

Factors believed to predispose to drug-induced oesophageal injury include taking drugs without water or immediately before lying down, a constricting lesion (eg oesophageal stricture or Schatzki ring) and impaired oesophageal motility. Oesophageal injury can present with severe symptoms, often with pain and odynophagia (painful swallowing), and can often be diagnosed clinically when symptoms develop following the ingestion of a medication known to cause this problemSaleem, 2021. If required, endoscopy may show focal ulceration at the gastro-oesophageal junction and, sometimes, the remains of the causative drug.

Treatment involves stopping the drug and giving pain relief and topical therapy (eg an antacidSaleem, 2021, a slurry of sucralfateSaleem, 2021, or a mixture of lidocaine 2% viscous oral liquid and magnesium hydroxide plus aluminium hydroxide suspension), often with a short period of acid suppression (eg 2 weeks of proton pump inhibitor therapy at the standard dose). Review the need for ongoing treatment with the causative drug. If the drug cannot be stopped or substituted, ensure the patient takes the drug with a full glass of water while upright (eg at least 30 minutes before bedtime if applicable) and preferably eats some food after taking the drugSaleem, 2021.

For the management of patients who have ingested a caustic agent, see Caustic ingestions in the Toxicology and Toxinology guidelines.