Mid-esophageal ulceration and candidiasis-associated distal esophagitis as two distinct clinical patterns of tetracycline or doxycycline-induced esophageal injury.
BACKGROUND
Tetracyclines may cause esophageal injury.


OBJECTIVE
The aims of this study are to describe 2 distinct clinical patterns of esophageal injury induced by tetracycline or its derivate doxycycline and to compare these patterns with respect to demographic, endoscopic, and clinical characteristics of the patients.


METHODS
Forty-eight patients with the diagnosis of doxycycline- or tetracycline-induced esophageal injury by endoscopy were analyzed retrospectively. The patients were considered in 2 groups according to the type and the location of esophageal lesions (Group A: mid-esophageal ulceration, n = 18; Group B: distal esophagitis, n = 30).


RESULTS
Patients in Group A were significantly younger than in Group B (P = 0.0014). In Group A, 15 patients (83%) had single ulceration, 2 (11%) double, and 1 (6%) circumferential at the mid-esophagus. In Group B, all patients had multiple micro-ulcerations in the distal esophagus. Development of mid-esophageal ulceration was induced predominantly by doxycycline, whereas distal esophagitis was induced by tetracycline. The description of drug ingestion with little or no water by patients in Group A was significantly more frequent than in Group B (94% vs. 10%, P < 0.001). Associated medical and benign gastric diseases and esophageal candidiasis were significantly more frequent in Group B (P = 0.006, P < 0.001, P < 0.001, respectively). Prompt response to medical therapy was observed in both groups with no significant difference (P = 0.093).


CONCLUSIONS
The type of tetracyclines used by patients may give some clues to physicians on the pattern of esophageal injury because mid-esophageal ulceration seems to be more frequently associated with doxycycline and distal esophagitis with or without candidiasis with tetracycline.
Gencosmanoglu
Rasim
R
Division of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey. rgencosmanoglu@marmara.edu.tr
Kurtkaya-Yapicier
Ozlem
O
Tiftikci
Arzu
A
Avsar
Erol
E
Tozun
Nurdan
N
Oran
Ebru Sen
ES
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001707:Biopsy, Needle; D002177:Candidiasis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004318:Doxycycline / Q000009:adverse effects* / Q000627:therapeutic use; D004941:Esophagitis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000293:injuries / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013752:Tetracycline / Q000009:adverse effects* / Q000627:therapeutic use
D013752:Tetracycline; D004318:Doxycycline