warfarin and Esophageal-Diseases

A case of intramural esophageal dissection is reported and the literature reviewed. Patients with intramural esophageal dissection are usually women in their seventh or eighth decade. The most common presenting symptoms are chest pain, dysphagia, and hematemesis. The diagnosis is made by contrast esophagography, esophagoscopy, or both. Nonoperative therapy has proved to be uniformly successful.

Topics: Aged; Esophageal Diseases; Female; Humans; Rupture, Spontaneous; Warfarin

BACKGROUND Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as endoscopic surgeries. Coagulation disorders increase the risk of IHE. The most common location of IHE is in the distal esophagus. The characteristic clinical triad of manifestations comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. CASE REPORT An 84-year-old male was scheduled for coil embolization for an endoleak after endovascular aneurysm repair. For this reason, he was taking aspirin and warfarin. A nasogastric tube had been inserted during surgery and subsequently removed without any problems reported. Postoperatively, he experienced chest pain and hematemesis of sudden onset. Urgent esophagogastroduodenoscopy demonstrated a large, dark red, non-pulsatile, submucosal, esophageal mass in the area of the mid-esophagus with a little oozing. He was diagnosed as having an IHE; other possible diagnoses were excluded by contrast-enhanced computed tomography and aortography. He was treated with fasting, a proton pump inhibitor, and cessation of anti-thrombotic drugs; he recovered completely. The bleeding spot in the esophagus was in the area of the mid-esophagus, which was around the second natural constriction site. It was possible that the nasogastric tube had contact with the esophageal wall at this second natural constriction, and caused intramural esophageal bleeding. CONCLUSIONS Nasogastric tubes are not generally recognized as a cause of IHE. However, they can cause them, especially when a patient is taking anti-thrombotic drugs.

Topics: Aged, 80 and over; Anticoagulants; Aspirin; Esophageal Diseases; Hematoma; Humans; Intubation, Gastrointestinal; Male; Platelet Aggregation Inhibitors; Warfarin

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Administration, Ophthalmic; Anticoagulants; Drug Substitution; Endoscopy, Gastrointestinal; Esophageal Diseases; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Hematoma; Humans; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Pantoprazole; Radiography, Thoracic; Rheumatic Diseases; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Pradaxa (dabigatran) is a direct thrombin inhibitor approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. We describe a case of esophageal ulceration associated with Pradaxa administration in a 75-year-old man. The patient reported difficulty swallowing and a burning sensation after taking his first dose of Pradaxa. An esophagogastroduodenoscopy (EGD) revealed linear ulcerations in the mid-esophagus. Pradaxa was held beginning the day before the EGD. The patient reported that his pain and difficulty swallowing resolved on stopping Pradaxa. Pradaxa is formulated with a tartaric acid excipient to reduce variability in absorption. We hypothesise that the capsule lodged in the patient's esophagus and the tartaric acid may have caused local damage resulting in an esophageal ulcer. It is important to educate patients on proper administration of Pradaxa, to decrease the risk of this rare, but potentially serious adverse event.

Topics: Aged; Anticoagulants; Dabigatran; Embolism; Endoscopy, Gastrointestinal; Esophageal Diseases; Helicobacter Infections; Helicobacter pylori; Humans; Male; Stomach; Ulcer; Warfarin

Intramural esophageal hematoma is part of a spectrum of esophageal injuries. Vomiting and straining, endoscopic procedures and bleeding disorders are the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia and hematemesis. Computed tomography is the modality of choice and treatment is medically conservative with the cessation of Warfarin and thrombolysis use. When anticoagulation and/or thrombolysis therapy is necessary, periodic reassessment for symptoms of intramural esophageal hematoma may be helpful for early identification and management. We described one case of intramural esophageal hematoma possibly resulting from anticoagulation and/or thrombolysis therapy in the setting of pulmonary embolism.

Topics: Aged; Anticoagulants; Chest Pain; Deglutition Disorders; Diagnosis, Differential; Esophageal Diseases; Fatal Outcome; Hematemesis; Hematoma; Humans; Male; Pulmonary Embolism; Thrombolytic Therapy; Tomography, X-Ray Computed; Warfarin

Oesophageal injury is a well recognized complication of certain oral medications but warfarin has not been implicated previously. We present a case of an oesophageal ulcer occurring in a patient with mitral regurgitation taking warfarin, and demonstrate a delayed oesophageal tablet transit time.

Topics: Drug Administration Schedule; Esophageal Diseases; Female; Humans; Middle Aged; Ulcer; Warfarin

A case of intramural oesophageal haematoma complicating anticoagulant therapy is described. Severe chest pain and complete obstruction of the oesophagus resulted. Early fibreoptic endoscopy facilitated the diagnosis. The condition resolved spontaneously with conservative management. A similar case has not been previously reported.

Topics: Aged; Esophageal Diseases; Hematoma; Humans; Male; Warfarin

Topics: Adult; Esophageal Diseases; Hematoma; Hemodialysis, Home; Heparin; Humans; Male; Radiography; Warfarin

Topics: Atrial Fibrillation; Esophageal Diseases; Esophagoscopy; Female; Hematoma; Humans; Middle Aged; Mitral Valve Stenosis; Warfarin