drug-induced esophagitis
Introduction
Introduction to drug-induced esophagitis Under normal circumstances, when oral administration, the drug quickly reaches the stomach from the oral cavity through the esophagus, and rarely causes adverse reactions of the esophagus, but if the esophagus itself is abnormal, such as compression, stenosis, movement disorder, gastroesophageal reflux, etc. Improper methods, such as taking medicine in the supine position, too little water in the medication, resulting in prolonged retention of the drug in the esophagus, some drugs can cause esophageal injury, this drug-induced esophageal mucosal injury is called drug-induced esophagitis (drug -inducedesophagitis). basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: Candidiasis
Cause
Cause of drug-induced esophagitis
(1) Causes of the disease
There are many kinds of pathogenic drugs for drug-induced esophagitis. Antibiotics are the most common drugs leading to drug-induced esophagitis. The esophageal injury is often not serious. A group of 40 patients reported that they took doxycycline (doxycycline) and tetracycline tablets. After the agent or capsule, esophageal ulcers were found in esophagoscopy. The esophageal ulcers caused by capsules accounted for the majority, indicating that the capsules were more likely to stay and dissolve in the esophagus than the tablets. Patients taking lincomycin and compound sulfamethoxazole also Visible esophageal ulcers, long-term application of broad-spectrum antibiotics can also cause esophageal candida infection.
The esophageal lesions caused by potassium chloride are mostly ulcers, others can be seen with stenosis, perforation, hemorrhage, etc. Pemberton reported that 1 patient who underwent mitral valve replacement for 10 days, esophageal stricture due to potassium chloride sustained-release tablets, esophagoscopy See the lower third of the esophagus with ulcer lesions and white secretions. McCall also reported that a patient with left atrial tumor-like dilatation leading to esophageal compression caused esophageal ulcers due to taking potassium chloride sustained-release tablets, causing massive esophageal hemorrhage and heart enlargement. Potassium chloride sustained-release tablets are retained in the esophageal compression section and delayed by the esophagus. Due to the strong stimulation and corrosive action of potassium chloride on the esophageal mucosa, it can cause esophageal exudation, hemorrhage, ulceration and stenosis, and even cause perforation, regardless of chlorination. Potassium sustained-release tablets or enteric potassium chloride tablets can cause severe esophageal damage.
Ambramide is used as an anticholinergic agent for the treatment of urinary incontinence and nocturia. It is usually taken before bedtime. Because the imammonium bromide tablet is inflated and disintegrated when exposed to water, such as no water or too little water when swallowed, its hygroscopic properties make it Adhesive to the esophageal mucosa, causing esophageal inflammation, ulcers and stenosis, the British Pharmacopoeia has banned the use of this drug.
Propranolol (properol), Apollo (heart decoction), iron preparations can cause esophageal ulcers, Pannuti oral treatment of 17 patients with digestive tract cancer with fluorouracil, 5 cases of stomach burning pain, post-sternal pressure And dysphagia, 3 cases of autopsy found necrotic esophagitis in the lower esophagus, and another reported 1 case, due to subcutaneous injection of chloramphenicol caused severe vomiting, resulting in the lower third of the esophagus tear, perforation, high dose hydration Chloral aldehyde and aspirin can stimulate esophageal stenosis and ulceration, digoxin, quinidine, sodium cromoglycate, zidovudine (azidothymidine), aminophylline, phenylbutazone, indomethacin, predni Pine can cause esophageal lesions.
(two) pathogenesis
The pathogenesis of drug-induced esophagitis is often related to several factors, and is often the result of a combination of these factors.
1. Esophageal diseases and abnormalities, including esophageal dyskinesia, such as incoordination of movement, sputum, nutcracker esophagus, gastroesophageal reflux disease, etc.; atrial enlargement, mediastinal tumor and other esophageal esophageal stricture; esophagus after mitral valve replacement Displacement or the like is liable to cause the drug to stay in the esophagus.
2. The chemical nature, physical solubility and contact time with the esophageal mucosa may affect the toxicity of the drug. Some drugs or high-concentration drugs are retained in the esophagus. Due to its physical and chemical properties, it can directly corrode the esophageal mucosa and dissolve the mucosal cell barrier, such as tetracycline. , aspirin and vitamin C, etc.
3. Some drugs can reduce the pressure of the lower esophageal sphincter and cause gastroesophageal reflux, and the acidic stomach contents will flow back into the esophagus, causing damage, such as theophylline, nitroglycerin, niacin and the like.
4. Long-term use of antibiotics, glucocorticoids and immunosuppressive drugs can damage the esophageal mucosa, and can cause esophageal candida infection.
5. Take the patient in the lying position immediately after taking the medicine, or the patient who drinks too little water or even drink water, which may cause the drug to stay in the esophagus and cause esophageal lesions.
6. The dosage form, shape and size are related to the esophageal lesions. Small, heavy, oval tablets are easier to swallow than large, light, round pills. Capsules are more likely to cause esophageal damage than tablets.
Prevention
Drug-induced esophagitis prevention
For drugs that can cause esophageal injury, care should be taken to change or change other drugs, especially those with abnormal structure and function in the elderly and esophagus. Patients taking sputum or standing position should take enough water to take clothes before going to bed. Patients should be reminded of the esophageal retention due to prone to esophageal retention. Patients who are bedridden and those with dysphagia should use liquid preparations or parenteral administration.
Complication
Drug esophagitis complications Complications candidiasis
Common manifestations are esophageal inflammation and esophageal ulcers, sometimes complicated by esophageal hemorrhage, stenosis, perforation, and infection with esophageal candidiasis.
Symptom
Drug-induced esophageal symptoms Common symptoms Persistent pain Esophageal wall fibrosis Radioactive pain Low fever Repeated hematemesis
1. Frequent sternal pain often occurs several hours, several days or even weeks after taking the drug. The pain is often persistent. After eating, the pain is aggravated and can be radiated to the neck, back and upper limbs. Some patients have swallowing pain, difficulty swallowing, low fever, hematemesis, black feces, etc., may be associated with foreign body sensation in the throat and tightness.
2. A small number of patients with atypical clinical symptoms show only symptoms of esophageal stricture after taking certain drugs. A small number of patients are misdiagnosed as myocarditis due to post-sternal pain with functional ST-T abnormalities.
Examine
Examination of drug-induced esophagitis
Laboratory inspection
When the disease is infected, the total number of white blood cells and the number of neutrophils in the blood increase.
Other auxiliary inspection
1. X-ray esophageal swallowing examination: visible haze of ulcers and mucosal edema around the ulcer, sometimes found esophageal stricture.
2. Esophagoscopy: visible inflammatory changes in the esophageal mucosa, such as redness of the mucosa, blurred blood vessels, erosion, ulcers, most visible exudation, and even bleeding and stenosis.
Diagnosis
Diagnosis and identification of drug-induced esophagitis
diagnosis
Diagnosis can be made based on medical history, clinical manifestations, and examination.
Differential diagnosis
The identification of drug-induced esophagitis and myocarditis is mainly:
1. Have a long history of taking medicine.
2. Endoscopic examination showed esophageal lesions.
3. Propranolol (property) test positive.
4. Stop the pathogenic drugs, esophagitis gradually reduce or disappear, the identification of drug-induced esophagitis and reflux esophagitis mainly depends on the cause and inflammation, the location of the ulcer, the former often occurs in drug siltation, while the latter mainly occurs In the lower part of the esophagus.
