Chemical gastritis after chronic bromazepam intake: a case report.
BACKGROUND
We describe a rare case of diffuse macroscopic discoloration and chemical gastritis due to chronic bromazepam intake. The chemical composition of pharmaceuticals has to be considered at endoscopy and it is evident that some chemical substances damage the epithelial tissue and lead to clinical symptoms.


METHODS
Endoscopy was performed in an 82-year-old patient due to gastroesophageal reflux symptoms and epigastric pain. Gastroscopy showed a hiatal hernia and a scarred duodenal bulb. More striking was the yellow-brownish discoloration of the gastric and the duodenal mucosa. The gastric antrum and the duodenal bulb showed local discoloration that could not be rinsed off. The medical history indicated that bromazepam (6 mg) had been used daily as a sleeping aid in the previous two years. The histopathological findings showed appearances of chemical gastritis. Within the lamina propria and on the epithelial surface there were granules. There was no foreign body reaction to these granules. Corpus mucosa showed a mild chronic gastritis.


CONCLUSIONS
If discoloration of the mucosa at endoscopy is seen, a careful drug history must be sought. This is the first case in literature that shows a chemical gastritis after bromazepam intake.
Kirschberg
Oliver
O
Department of Internal Medicine II, University of Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimerstrasse 200, D-51109 Cologne, Germany. kirschbergo@kliniken-koeln.de
Saers
Thomas
T
Krakamp
Bernd
B
Brockmann
Michael
M
D000369:Aged, 80 and over; D001960:Bromazepam / Q000009:adverse effects* / Q000627:therapeutic use; D004724:Endoscopy; D018757:GABA Modulators / Q000009:adverse effects* / Q000627:therapeutic use; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D012893:Sleep Wake Disorders / Q000188:drug therapy
D018757:GABA Modulators; D001960:Bromazepam