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Gastrointestinal Imaging

Oesophagitis, drug-induced

focal oesophagitis secondary to chemical injury to the oesophageal mucosa caused by a variety of medications. Also called pill oesophagitis. The properties of the pills that will determine local injury are its specific chemical nature, the pH, its solubility and its contact time with the mucosa. Patient factors that predispose to pill oesophagitis are disturbances in the motility (achalasia, scleroderma), narrowing of the lumen due to stricture or tumour and taking the pill with minimal fluid or in the supine position. The lesions are usually situated in the proximal and middle third of the oesophagus. A predilection site is the level of the aortic arch because of the lumen narrowing of the oesophagus due to the aortic crossing. Symptoms related to pill oesophagitis are dysphagia and odynophagia.

Radiographic features on barium study include focal mucosal irregularity, superficial mucosal ulceration and luminal narrowing. These changes are reversible in the large majority of patients but may exceptionally lead to a persisting fibrous stricture.

ALB