Esophagus
Esophagitis
Pill induced esophagitis
Author: Elliot Weisenberg, M.D.
Last author update: 1 October 2012
Last staff update: 28 June 2023
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Pill induced esophagitis
Table of Contents
Definition / general | Kayexalate damage | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Additional references | Board review style question #1 | Board review style answer #1Cite this page: Weisenberg E. Pill induced esophagitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophaguspillinduced.html. Accessed April 25th, 2024.
Definition / general
- Pills sticking in esophagus cause local injury, often in mid esophagus (J Clin Gastroenterol 1999;28:298)
- Often doxycycline and other antibiotics, aspirin and NSAIDs, slow release potassium, ferrous salts, alendronate (Fosamax) (Mod Pathol 1999;12:1152)
- Associated with diabetes and ischemic heart disease, advanced age; more common in women (Endoscopy 2005;37:740)
- May rarely cause strictures
- Prevention: take pills when upright and with adequate fluids (Curr Treat Options Gastroenterol 2004;7:71, Drug Saf 2000;22:237)
- Endoscopy: erosions, kissing ulcers, multiple small ulcerations with bleeding, mainly in mid esophagus
Kayexalate damage
- Kayexalate (sodium polystyrene sulfonate) in sorbitol is used to treat hyperkalemia
- Symptoms are from sorbitol, given orally though NG tube or as an enema, may crystallize in esophagus, stomach or duodenum and produce endoscopic ulcers and erosions resembling carcinoma or Candida (Am J Surg Pathol 2001;25:637)
- Colonic infarction and erosions reported
- Crystals are lightly basophilic with a faint crystalline mosaic pattern, better seen with PAS / Alcian blue
- Crystals are refractile but not polarizable, luminal and adherent to intact surface epithelium or mixed with inflammatory exudate in patients with ulcer or erosion
Case reports
- 43 year old man with case resulting from telithromycin (Turk J Gastroenterol 2006;17:113)
- 65 year old man with history of esophageal cancer and end stage renal disease (Case #460)
- 70 year old man with case resulting from rifampin (Ann Pharmacother 1999;33:27)
- 2 cases resulting from alendronate and doxycycline (Rom J Gastroenterol 2005;14:159)
- Woman with case resulting from oral contraceptive Diane 35 (Int J Clin Pract Suppl 2005;147:79)
- Procardia extended release (J Assoc Acad Minor Phys 1997;8:38)
- Tamsulosin for prostatic hypertrophy (Dig Liver Dis 2004;36:632)
Microscopic (histologic) description
- Inflammatory exudate, ulceration, inflamed granulation tissue, prominent eosinophils, necrotic squamous epithelium, polarizable crystalline foreign material, multinucleated giant cells
- Fungi or viral inclusions present in 20% of cases due to alendronate
Microscopic (histologic) images
Contributed by Ankur Sangoi, M.D.
Kayexalate damage:
Various images
AFB stain
Additional references
Board review style question #1
Which of the following microscopically identifiable medication materials typically shows a 2 tone appearance with a fish scale pattern on H&E?
- Cholestyramine
- Crospovidone
- Sevelamer
- Sodium polystyrene sulfonate
Board review style answer #1
