Drug-induced oesophageal disorders - Pathogenesis, incidence, prevention and management

Drug-induced injury of the oesophagus is a common cause of oesophageal comp laints. 'Pill-induced' oesophagitis is associated with the ingestion of cer tain drugs and accounts for many cases of erosive oesophagitis. To date, mo re than 70 drugs have been reported to induce oesophageal disorders. Antiba cterials such as doxycycline, tetracycline and clindamycin are the offendin g agents in more than 50% of cases. Other commonly prescribed drugs that ca use oesophageal injury include aspirin (acetylsalicylic acid), potassium ch loride, ferrous sulfate. quinidine, alprenolol and various steroidal and no nsteroidal anti-inflammatory agents. However, many physicians and even more patients are not aware of this problem. Capsules or tablets are commonly delayed in their passage through the oesop hagus. Highly caustic coatings, direct medication injury and poor oesophage al clearance of pills can lead to acute inflammation. Oesophageal damage oc curs when the caustic contents of a drug remain in the oesophagus long enou gh to produce mucosal lesions. Taking medications at bedtime or without flu ids is a common cause of oesophagitis. The possibility of drug-related damage should be suspected in all cases of oesophagitis, chest pain and dysphagia. History and gastrointestinal endosc opy will confirm the diagnosis. Treatment is supportive, although acid redu ction is used frequently as an adjunct. This review reflects the current st ate of knowledge in this field.