Alvares J F, Kulkarni S G, Bhatia S J, Desai S A, Dhawan P S
Department of Gastroenterology, T N Medical College, Mumbai.
Indian J Gastroenterol. 1999 Jul-Sep;18(3):115-7.
Few prospective studies are available on the incidence of medication-induced esophageal injury (MIEI).
To prospectively study the occurrence of MIEI with indomethacin and doxycycline and the predictive factors for its development.
In an operator-blinded study, 51 patients (age 16-65 y) requiring indomethacin (n = 24) or doxycycline (27) underwent symptom evaluation, endoscopy and scintigraphy before and after 7 days of therapy. MIEI was defined as de novo occurrence or worsening of pre-existing esophagitis or development of esophageal ulcer.
Pre-therapy endoscopy was normal in 32 patients and revealed esophagitis in 19 (grade I--11, grade II--8). Post-therapy, 16 patients developed esophageal symptoms, which appeared earlier with doxycycline (2.0 [0.8] vs 4.1 [1.7] days, p = 0.016). MIEI developed in 23 patients--de novo esophagitis in 16, worsening of esophagitis in 6; 5 patients developed ulcer. Seven of 12 patients with hiatus hernia developed MIEI. Presence of pre-therapy gastroesophageal reflux disease did not predict MIEI. There was no difference in pre- or post-therapy transit values between patients with and without MIEI; patients who developed ulcers had significantly slower esophageal transit (p < 0.05). There was no difference in esophageal transit or occurrence of MIEI between patients who received indomethacin or doxycycline; however, 5 of 8 patients with hiatus hernia who received doxycycline developed MIEI (p = 0.02; relative risk 3.96 [CI 1.2-12.7]).
40% of patients receiving doxycycline or indomethacin developed MIEI; 10% developed ulcers. Hiatus hernia increased the risk for MIEI.
关于药物性食管损伤（MIEI）发病率的前瞻性研究较少。
前瞻性研究吲哚美辛和强力霉素导致MIEI的发生情况及其发展的预测因素。
在一项操作者盲法研究中，51例（年龄16 - 65岁）需要使用吲哚美辛（n = 24）或强力霉素（27例）的患者在治疗7天前后接受症状评估、内镜检查和闪烁扫描。MIEI定义为新发食管炎或原有食管炎恶化或食管溃疡形成。
治疗前32例患者内镜检查正常，19例显示有食管炎（I级 - 11例，II级 - 8例）。治疗后，16例患者出现食管症状，强力霉素组症状出现更早（2.0 [0.8]天对4.1 [1.7]天，p = 0.016）。23例患者发生MIEI，其中16例新发食管炎，6例原有食管炎恶化，5例出现溃疡。12例有食管裂孔疝患者中有7例发生MIEI。治疗前存在胃食管反流病不能预测MIEI。发生MIEI和未发生MIEI的患者治疗前后的通过时间值无差异；发生溃疡的患者食管通过明显更慢（p < 0.05）。接受吲哚美辛或强力霉素的患者在食管通过或MIEI发生方面无差异；然而，8例接受强力霉素的食管裂孔疝患者中有5例发生MIEI（p = 0.02；相对风险3.96 [CI 1.2 - 12.7]）。
接受强力霉素或吲哚美辛的患者中40%发生MIEI；10%发生溃疡。食管裂孔疝增加了MIEI的风险。
