Abstract
Six consecutive cases of drug-induced esophageal ulcer were presented with special reference to their endoscopic characteristics. Causative drugs were a doxycycline hydrochloride (Vibramycin) capsule in four cases, a Vi-bramycin tablet and a clindamycin hydrochloride (Dalacin) capsule in one case respectively. As to the patient's history, it is very characteristic that they took a capsule or a tablet just before or even after lying in bed, with no or only small amount of water. The symptoms were substernal burning pain and odynophagia. It was common in all cases that the symptoms appeared very soon or within several hours after taking the drug. These drug-induced esophagal ulcers healed very rapidly. The symptoms disappeared completely within 6 to 15 days (8.5 days on an average), and the ulcers healed endoscopically on the 6th to 18th clinlcal day (11th day as a mean). The diagnosis is fairly easy because of the characteristic history and the relationship to the drugs. Actually from the 2nd case in our series, we were able to suspect almost exclusively a diagnosis of drug-induced esophageal ulcer only by hearing the characteristic history mentioned above, and successfully confirmed it by immediately endoscopy. Endoscopy was performed within 4.8±2.0 days and successfully confirmed fresh ulcers in all cases. The ulcers were multiple, shallow and irregular both in shape and size. In cases of Vibramycincapsule, there was a main ulcer, comparatively bigger and deeper one, and the rest of the ulcers were scattered around or distal of it. These features might be closely related to the lodgement of a dissolving capsule and the spreading of the strongly acid content. Endoscopy should be performed as soon as possible. Otherwise the ulcers might not be found because of the fairly rapid healing.
