tetracycline and Esophagitis

Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Doxycycline; Esophageal Perforation; Esophagitis; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Pain; Pseudotumor Cerebri; Tetracycline

Prevalence and incidence of drug-related esophagitis are probably underestimated. The condition can often be diagnosed on the basis of history alone. Tetracyclines and emepronium bromide were implicated in most published cases. Endoscopy usually shows erosions in the upper two thirds of the esophagus. These esophageal lesions generally heal after the medication has been stopped. Complications such as stricture, hemorrhage or perforation are very rare.

Topics: Adolescent; Adult; Aged; Drug-Related Side Effects and Adverse Reactions; Emepronium; Esophagitis; Esophagoscopy; Female; Humans; Incidence; Male; Middle Aged; Prevalence; Switzerland; Tetracycline

Medication induced esophagitis (MIE) has been reported in dermatology patients taking tetracycline antibiotics. The symptoms of esophagitis, preventable with proper instruction, can create morbidity and lead to increased costs for patients. Our study sought to quantify the incidence of MIE in patients taking tetracycline antibiotics and to investigate how these patients develop MIE. A cross-sectional questionnaire survey was given at outpatient dermatology clinics. Ninety-three surveys from patients who had taken tetracycline antibiotics and 48 surveys from a control group were analyzed. Incidence of esophagitis symptoms (difficulty or pain with swallowing) was measured in both survey and control groups. We found that esophagitis is significantly more common in patients taking tetracycline and its derivatives as compared with a control group (p<.03). Patients should be counseled to take tetracycline antibiotics in an upright position with a large amount of fluid and to report esophagitis symptoms to the prescribing physician.

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Cross-Sectional Studies; Esophagitis; Female; Hospitals, University; Humans; Male; Middle Aged; Ohio; Severity of Illness Index; Skin Diseases; Surveys and Questionnaires; Tetracycline

Tetracyclines may cause esophageal injury.. The aims of this study are to describe 2 distinct clinical patterns of esophageal injury induced by tetracycline or its derivate doxycycline and to compare these patterns with respect to demographic, endoscopic, and clinical characteristics of the patients.. Forty-eight patients with the diagnosis of doxycycline- or tetracycline-induced esophageal injury by endoscopy were analyzed retrospectively. The patients were considered in 2 groups according to the type and the location of esophageal lesions (Group A: mid-esophageal ulceration, n = 18; Group B: distal esophagitis, n = 30).. Patients in Group A were significantly younger than in Group B (P = 0.0014). In Group A, 15 patients (83%) had single ulceration, 2 (11%) double, and 1 (6%) circumferential at the mid-esophagus. In Group B, all patients had multiple micro-ulcerations in the distal esophagus. Development of mid-esophageal ulceration was induced predominantly by doxycycline, whereas distal esophagitis was induced by tetracycline. The description of drug ingestion with little or no water by patients in Group A was significantly more frequent than in Group B (94% vs. 10%, P < 0.001). Associated medical and benign gastric diseases and esophageal candidiasis were significantly more frequent in Group B (P = 0.006, P < 0.001, P < 0.001, respectively). Prompt response to medical therapy was observed in both groups with no significant difference (P = 0.093).. The type of tetracyclines used by patients may give some clues to physicians on the pattern of esophageal injury because mid-esophageal ulceration seems to be more frequently associated with doxycycline and distal esophagitis with or without candidiasis with tetracycline.

Topics: Adult; Age Distribution; Aged; Biopsy, Needle; Candidiasis; Dose-Response Relationship, Drug; Doxycycline; Esophagitis; Esophagoscopy; Esophagus; Female; Humans; Immunohistochemistry; Incidence; Male; Middle Aged; Probability; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Tetracycline

Topics: Acne Vulgaris; Adolescent; Doxycycline; Esophagitis; Esophagoscopy; Female; Humans; Male; Tetracycline

Ulcerative esophagitis may be caused by corrosive agents and by commonly prescribed medications. We report severe esophagitis in five adolescents after ingestion of tetracycline preparations with minimal water immediately before going to bed.

Topics: Adolescent; Adult; Doxycycline; Esophagitis; Female; Humans; Male; Tetracycline; Ulcer

A review of the 127 cases of drug-induced esophagitis reported since 1970 indicates that commonly used medications may be a source of esophageal injury. Retrosternal pain, odynophagia, and dysphagia were the most commonly reported symptoms and most cases were self-limited with 7 to 10 days of symptomatic therapy. Occasionally, severe odynophagia or dysphagia necessitated hospitalization. Emepronium bromide, tetracycline, and its derivatives, potassium chloride, and quinidine accounted for 89% of the reported cases; the remaining 11% were caused by 14 other medications. Serious sequelae, including death, have been linked to potassium-induced esophageal injury. With other medications, however, serious complications were rare. The diagnostic study of choice for suspected medication-induced esophageal injury is endoscopy, although air contrast barium swallow may often detect subtle mucosal abnormalities. In uncomplicated cases the history alone may be sufficient to make the diagnosis. Concurrent ingestion of adequate amounts of fluid and avoidance of unnecessary bedtime medications may help to prevent medication-induced esophageal injury.

Topics: Adolescent; Adult; Aged; Child; Doxycycline; Drug-Related Side Effects and Adverse Reactions; Emepronium; Esophagitis; Female; Humans; Male; Middle Aged; Minocycline; Potassium Chloride; Quinidine; Tetracycline

Two cases of esophageal injury secondary to drugs are hereby presented, reviewing the different types of drugs, predisposing factors, physiopathology and complications.

Topics: Adult; Demeclocycline; Esophagitis; Esophagoscopy; Esophagus; Humans; Male; Middle Aged; Tetracycline

Clinical, radiographic, and endoscopic features of medication-induced esophagitis (MIE) in 4 patients are described. When the clinical history and symptoms raise a high index of suspicion for MIE, a double-contrast esophagram or endoscopic examination should be performed. The proximal esophagus, particularly the aortic segment, and occasionally the distal esophagus are the sites most commonly affected by MIE. Superficial mucosal erosions, shallow ulcers, and subtle mucosal alterations can be demonstrated by double-contrast esophagrams if careful attention is paid during performance and interpretation of these studies in an appropriate clinical setting.

Topics: Adult; Doxycycline; Esophagitis; Esophagus; Female; Humans; Ibuprofen; Male; Middle Aged; Radiography; Tetracycline; Ulcer

Topics: Administration, Oral; Adult; Aged; Esophagitis; Female; Humans; Male; Middle Aged; Tetracycline; Time Factors

Topics: Adult; Emergencies; Esophagitis; Female; Humans; Tetracycline; Urethritis

Topics: Esophagitis; Female; Humans; Middle Aged; Tetracycline

Topics: Doxycycline; Emepronium; Esophagitis; Humans; Minocycline; Quaternary Ammonium Compounds; Tablets; Tetracycline; Tetracyclines

Patients with esophageal symptoms following drug ingestion underwent double-contrast upper gastrointestinal studies, and radiographic findings are described. Superficial esophageal ulceration and subtle mucosal abnormalities, which have not been seen on single-contrast radiographs, were confirmed on double-contrast radiographs. Erosions or ulcers usually occur in the region of the aortic arch and occasionally lower in the esophagus. Repeat esophagrams after withdrawal of the medication indicate resolution of the symptoms.

Topics: Adult; Barium Sulfate; Doxycycline; Esophagitis; Esophagus; Female; Humans; Male; Middle Aged; Quinidine; Radiography; Tetracycline; Ulcer

Topics: Adolescent; Esophagitis; Humans; Tetracycline; Ulcer

Topics: Adult; Complement Fixation Tests; Esophagitis; Herpes Simplex; Humans; Male; Mycoplasma; Simplexvirus; Stevens-Johnson Syndrome; Tetracycline

Topics: Adult; Candida albicans; Candidiasis; Diagnosis, Differential; Esophageal Neoplasms; Esophagitis; Esophagoscopy; Humans; Male; Penicillins; Respiratory Tract Infections; Tetracycline

Topics: Adult; Aged; Esophagitis; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Intestines; Male; Middle Aged; Oleandomycin; Pancreatitis; Tetracycline

Topics: Anti-Bacterial Agents; Candidiasis; Candidiasis, Oral; Deglutition Disorders; Diagnosis; Esophagitis; Humans; Nystatin; Pneumonia; Prednisolone; Radiography; Sulfonamides; Tetracycline