title: NSAID-induced pyloric stenosis leading to oesophageal intramucosal dissection.
abstract: We describe a rare case of a 75-year-old woman with significant non-steroidal anti-inflammatory drug (NSAID) use who presented with haematemesis. Upper endoscopy revealed a large (9 cm) intramucosal dissection of the oesophagus without extension into the gastro-oesophageal junction and a severely narrowed pylorus. We postulate that she developed pyloric stenosis due to peptic ulcer disease from chronic NSAID use. This then led to gastro-oesophageal reflux. Undigested pills in the refluxate had contacted oesophageal mucosa, leading to pill-induced oesophageal injury. This, along with vomiting, is postulated to have led to the oesophageal intramucosal dissection. She improved with conservative medical management with a clear liquid diet and proton pump inhibitors, and a follow-up upper endoscopy 1 week later showed recovery of the previously seen intramucosal dissection.
authors.affiliation: Department of Medicine, University of Arizona College of Medicine, Tucson, USA.
authors.forename: Kai Rou
authors.initials: KR
authors.lastname: Tey
authors.affiliation: Department of Gastroenterology, University of Arizona, Tucson, Arizona, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kemmerly
authors.affiliation: Department of Gastroenterology, University of Arizona, Tucson, Arizona, USA.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Banerjee
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000072700:Conservative Treatment; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D010437:Peptic Ulcer / Q000139:chemically induced / Q000150:complications*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011707:Pyloric Stenosis / Q000209:etiology / Q000628:therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors