Maesaka Kazuki, Tsujii Yoshiki, Shinzaki Shinichiro, Yoshii Shunsuke, Hayashi Yoshito, Iijima Hideki, Nakamoto Kei, Ohtani Tomohito, Sakata Yasushi, Takehara Tetsuo
Department of Gastroenterology and Hepatology.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Medicine (Baltimore). 2018 Nov;97(48):e13380. doi: 10.1097/MD.0000000000013380.
Although esophageal compression due to cardiomegaly may be a risk factor of drug-induced esophageal injuries (DIEIs), the causal relationship between the two conditions has not been fully demonstrated.
We present a case of a drug-induced esophageal ulcer caused by left atrial enlargement in a 44-year-old woman with end-stage hypertrophic cardiomyopathy. Upper gastrointestinal endoscopy showed a deep, circumferential ulcer in the middle thoracic esophagus. CT revealed that the esophagus was compressed between the enlarged left atrium (LA) and the vertebral body. In the upper gastrointestinal series, retention of contrast media was observed in the esophagus near the LA.
The ulcer was a result of potassium chloride retention in the esophagus, which was compressed by the enlarged LA.
After cessation of potassium chloride administration for 2 months, the ulcer healed and a stricture developed. Two years after the ulcer development, the patient underwent heart transplantation, and subsequent endoscopic balloon dilation was performed for the esophageal stricture.
The patient's oral intake recovered completely without any ulcer recurrence.
The case demonstrated that esophageal compression by the enlarged LA caused a drug-induced esophageal ulcer. Preventive care and treatment measures for DIEIs, including an anatomical approach, should be considered for patients with LA enlargement.
尽管心脏肥大导致的食管受压可能是药物性食管损伤（DIEIs）的一个危险因素，但这两种情况之间的因果关系尚未得到充分证实。
我们报告一例44岁终末期肥厚型心肌病女性因左心房扩大导致的药物性食管溃疡病例。上消化道内镜检查显示胸段食管中部有一个深的环形溃疡。CT显示食管被扩大的左心房（LA）和椎体挤压。在上消化道造影检查中，在左心房附近的食管中观察到造影剂潴留。
溃疡是由于扩大的左心房挤压食管导致氯化钾潴留所致。
停用氯化钾2个月后，溃疡愈合并出现狭窄。溃疡发生两年后，患者接受了心脏移植，随后对食管狭窄进行了内镜球囊扩张。
患者的经口摄入量完全恢复，无溃疡复发。
该病例表明，扩大的左心房对食管的压迫导致了药物性食管溃疡。对于左心房扩大的患者，应考虑采取包括解剖学方法在内的DIEIs预防护理和治疗措施。
