[Ulcerative esophagitis associated with the use of alendronate sodium: histopathological and endoscopic features].
BACKGROUND
Drug-induced or "pill-induced" esophagitis may be secondary to the prolonged contact of the drug with the esophageal mucosa or secondary to the drug ability to alter the local conditions. The alendronate sodium, a bone resorption inhibitor used in the treatment and prevention of osteoporosis, has been cited, recently, as one of the causes of adverse upper gastrointestinal tract injury.


OBJECTIVE
To describe the clinical, endoscopic and histopathological features of patients with ulcerative esophagitis associated with alendronate sodium.


METHODS
Four women and one man with osteoporosis were treated with alendronate sodium and submitted to endoscopy followed esophageal biopsy.


RESULTS
The age range of the patients was from 64 to 84 years old. The patients showed dyspeptic symptoms after taking alendronate sodium during a period of 2-12 months. At endoscopic evaluation, the mucosa was friable, with erosion and/or ulceration covered by fibrin in the distal esophagus. The pathological examination of the esophageal biopsies revealed ulcerative esophagitis characterized by necrofibrinpurulent material, granulation tissue, and yellow refractile polarizable crystal. The patients' symptoms resolved after stopping alendronate sodium use.


CONCLUSIONS
The esophagus injuries associated with alendronate sodium are not frequent and seem to be associated with the incorrect use of medication. The endoscopists and pathologists should be alert to the possibility of alendronate sodium therapy in cases of diagnosis of ulcerative esophagitis in ancient patients, particularly in women. The recognition of this condition would improve the patient care.
Fernandes
Paula Avila
PA
Laborat rio N cleo - Anatomia Patol gica e Citopatologia, Belo Horizonte, MG.
Pires
Marcelo Soares
MS
Gouvêa
Agostinho Pinto
AP
D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects* / Q000627:therapeutic use; D004941:Esophagitis / Q000139:chemically induced* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy; D014456:Ulcer / Q000139:chemically induced* / Q000473:pathology
D019386:Alendronate