El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Pill Esophagitis. This 65 year-old male, undergone an upper endoscopy due to epigastric pain, denies having fevers, nausea, vomiting, odynophagia and dysphagia was treated with.alendronate (Fosamax®) and aspirin over the past months.

Video Endoscopic Sequence 1 of 5.

Pill Esophagitis

 This 65 year-old male, undergone an upper endoscopy due
 to epigastric pain, denies having fevers, nausea, vomiting,
 odynophagia and dysphagia was treated with alendronate
 (Fosamax®) and aspirin over the past months.

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Esophageal lesions can result from ingested medication which undergoes slow transient through esophagus with resulting prolonged mucosal contact and caustic damage. Typical agents include potassium chloride, quinidine, ascorbic acid, tetracyclines, NSAIDS, and bisphophonates. It is important that these medications be accompanied with ample water to prevent slow esophageal transit. One study of aspirin sized barium tablets administered to patients undergoing routine upper GI showed that half remained in the esophagus for more than 5 minutes. Bisphosphonates are particularly notorious for causing esophageal irritation.

Video Endoscopic Sequence 2 of 5.

 Esophageal lesions can result from ingested medication
 which undergoes slow transient through esophagus with
 resulting prolonged mucosal contact and caustic damage.
 Typical agents include potassium chloride, quinidine,
 ascorbic acid, tetracyclines, NSAIDS, and bisphophonates.

 It is important that these medications be accompanied with
 ample water to prevent slow esophageal transit. One study
 of aspirin sized barium tablets administered to patients
 undergoing routine upper GI showed that half remained in
 the esophagus for more than 5 minutes. Bisphosphonates
 are particularly notorious for causing esophageal irritation.

Tetracyclines are the most common antibiotics to induce esophagitis, particularly doxycycline. Essentially all of the antiinflammatory agents can damage the esophagus; the highest number of reported cases have been with aspirin. The major offenders in the "other" category include potassium chloride, quinidine preparations, and iron compounds in the United States; emepronium, alprenolol, and pinaverium are common etiologies in other countries. In addition, the bisphosphonate alendronate has the potential to be a cause because of its increasing use for the treatment of osteoporosis and other disorders .

Video Endoscopic Sequence 3 of 5.

  • Tetracyclines are the most common antibiotics to induce esophagitis, particularly doxycycline
  • Essentially all of the antiinflammatory agents can damage the esophagus; the highest number of reported cases have been with aspirin.
  • The major offenders in the "other" category include
    potassium chloride, quinidine preparations, and iron
    compounds in the United States; emepronium, alprenolol,
    and pinaverium are common etiologies in other countries.
    In addition, the bisphosphonate alendronate has the
    potential to be a cause because of its increasing use for the
    treatment of osteoporosis and other disorders.
PATHOGENESIS ? The mechanism of injury is believed to be due to prolonged contact of the caustic contents of the medication with the esophageal mucosa. Esophageal retention ? Some degree of esophageal retention of pills or capsules occurs in normal individuals. However, the following situations enhance pill retention, thereby increasing the likelihood of esophageal injury: Both lack of an adequate liquid bolus and a long period in the recumbent position are believed to play a major role in pill retention. Ingestion of a pill immediately prior to sleep favors prolonged retention since salivation and swallowing frequency are markedly reduced during sleep.

Video Endoscopic Sequence 4 of 5.

 PATHOGENESIS — The mechanism of injury is believed
 to be due to prolonged contact of the caustic contents of
 the medication with the esophageal mucosa.

 Esophageal retention — Some degree of esophageal
 retention of pills or capsules occurs in normal individuals.
 However, the following situations enhance pill retention,
 thereby increasing the likelihood of esophageal injury:

  • Both lack of an adequate liquid bolus and a long period in the recumbent position are believed to play a major role in pill retention.
  • Ingestion of a pill immediately prior to sleep favors prolonged retention since salivation and swallowing frequency are markedly reduced during sleep.
Pills. Esophagitis can result when a swallowed pill gets stuck in the throat and burns the lining, usually when not enough liquid was used to wash down the pill. It may also occur if the esophagus does not contract properly or is narrowed because of a scar.

Video Endoscopic Sequence 5 of 5.

 Pills. Esophagitis can result when a swallowed pill gets
 stuck in the throat and burns the lining, usually when not
 enough liquid was used to wash down the pill. It may also
 occur if the esophagus does not contract properly or is
 narrowed because of a scar.