Читать книгу The Esophagus - Группа авторов - Страница 175

Tetracycline and its derivative, doxycycline, are two of the agents most commonly responsible for drug‐induced esophagitis in the United States, but other offending medications include potassium chloride, quinidine, aspirin or other non‐steroidal anti‐inflammatory drugs (NSAIDs), and alendronate [97]. Affected individuals typically ingest the medications with little or no water immediately before going to bed. The pills or capsules tend to become lodged in the upper or mid esophagus, which is compressed by the adjacent aortic arch or left main bronchus. Prolonged contact of the esophageal mucosa with the pills presumably causes a focal contact esophagitis. These patients may present with severe odynophagia, but there is often marked clinical improvement after withdrawal of the offending agent.

The radiographic findings in drug‐induced esophagitis depend on the nature of the offending medication. Tetracycline and doxycycline are associated with the development of small, superficial ulcers in the upper or mid esophagus indistinguishable from those in herpes esophagitis [98, 99] (Figure 6.51). Because of the superficial nature of the disease, these ulcers almost always heal without associated scarring or stricture formation. In contrast, potassium chloride, quinidine, and NSAIDs may cause more severe esophageal injury, sometimes leading to the development of much larger ulcers and subsequent strictures [100] (Figure 6.52). Alendronate may also cause a severe form of esophagitis with extensive ulceration and strictures, but these strictures are usually confined to the distal esophagus [101]. When drug‐induced esophagitis is detected on barium studies, a repeat esophagram may be performed to document ulcer healing after withdrawal of the offending medication.

Figure 6.37 Reflux esophagitis with ulceration. (A) Double‐contrast view shows shallow linear and punctate ulcers (arrows) in the distal esophagus above a hiatal hernia.

Source: Reproduced from Levine [73], with permission.

(B) Double‐contrast view in another patient shows a single flat ulcer (arrow) on the posterior wall of the distal esophagus.

Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.

Figure 6.38 Reflux esophagitis with thickened folds. Double‐contrast view shows considerably thickened folds in the esophagus caused by edema and inflammation extending into the submucosa. Compare this image to the normal appearance of the longitudinal folds in Figure 6.35B.

Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.

Figure 6.39 Reflux esophagitis with inflammatory esophagogastric polyp. Prone single‐contrast view shows a prominent fold arising at the cardia and extending into the distal esophagus as a smooth polypoid protuberance (arrow). This appearance is characteristic of an inflammatory esophagogastric polyp.

Figure 6.40 Scarring of distal esophagus with fixed transverse folds. Double‐contrast view shows minimal narrowing of the distal esophagus above a hiatal hernia. Also note sacculation (white arrows) of the wall and pooling of barium between transverse folds (black arrows), producing a “stepladder” appearance.

Source: Reproduced from Levine MS and Laufer I. The upper gastrointestinal series at a crossroads. AJR Am J Roentgenol1993; 161:1131–1137, with permission.