Pill-induced oesophagitis

Correspondence to Dr Misbahuddin Syed, Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA; Misbahuddin.Syed@moffitt.org A 67-year-old woman with adenocarcinoma of the lung, who previously received chemotherapy and radiation therapy, presented with acute-onset right lower extremity weakness. Oesophageal injury from medications typically occurs in areas with existing anatomic narrowing, and this risk is often higher in those with gastro-oesophageal reflux disease.1 In the setting of radiation therapy, the risk of oesophageal stricture increases with the intensity of therapy, and often develops up to 6 months following completion of treatment; this risk is accentuated in those who also received chemotherapy.2 The patient’s history of chemotherapy and radiotherapy likely led to oesophageal stricture, increasing her risk of drug-induced oesophagitis. The middle third of the oesophagus is among the most common areas involved.3 Frequently implicated medications include antibiotics, non-steroidal anti-inflammatory agents, bisphosphonates, potassium chloride and chemotherapeutic agents.4 Affected patients can present with chest pain, odynophagia or dysphagia.5 Endoscopy remains the gold standard at definitive diagnosis, and permits for concurrent therapeutic intervention.