Читать книгу Gastrointestinal Pathology - Группа авторов - Страница 76

Medication‐related injury to the esophageal mucosa (“pill esophagitis”) is an increasingly recognized complication of orally administered drugs. Mucosal injury is typically caused by prolonged direct contact and local caustic effects of the offending agent, although mechanisms of toxicity may be complex and multifactorial. Numerous drugs have been implicated (Table 2.7). Most cause a nonspecific injury pattern, and the diagnosis is suggested by the clinical history.

Elderly patients and women are most commonly affected. The elderly often have multiple underlying risk factors, and the female predominance is attributed to the more common use of certain medications in this group, such as iron supplements and bisphosphonates. Risk factors include pills taken with little or no water or while recumbent, underlying disorders of esophageal motility (e.g. diabetes, strictures, achalasia) and disorders of local anatomy causing external compression (enlarged left atrium, aortic aneurism). However, many patients do not exhibit abnormal esophageal function or other risk factors.