Zhou Yi, Dai Yancheng, Lu Lei, Fu Zhiquan
Department of Gastroenterology, Shanghai Hospital of Integrated Traditional Chinese and Western Medicine.
Institute of Digestive Diseases, LongHua Hospital.
Medicine (Baltimore). 2020 Apr;99(17):e19890. doi: 10.1097/MD.0000000000019890.
Dabigatran is an anticoagulant medication that has been widely used to prevent strokes caused by atrial fibrillation, deep vein thrombosis, and pulmonary embolism. However, the potential adverse effect of dabigatran of gastrointestinal mucosal injury is often neglected, and even induces esophagitis.
A 77-year-old woman was admitted to the hospital with symptoms of progressive retrosternal pain, upper abdominal discomfort, and dysphagia.
Esophagogastroduodenoscopy showed longitudinal sloughing mucosal casts in the distal esophagus. Histological examination showed squamous epithelium with neutrophil infiltration, partial epithelial degeneration, and Helicobacter pylori. Based on a literature review, medical history, and imaging examination, the patient was diagnosed with dabigatran-induced esophagitis.
The patient recovered with standard H. pylori eradication therapy and proton pump inhibitor without discontinuing dabigatran.
After 2 weeks, the retrosternal pain and dysphagia were relieved and upper abdominal discomfort was attenuated.
Our case highlights the importance of physicians' awareness of the clinical and endoscopic characteristics of dabigatran-induced esophagitis and the importance of H. pylori-associated tests and eradication if necessary for patients with long-term dabigatran treatment.
达比加群是一种抗凝药物，已被广泛用于预防房颤、深静脉血栓形成和肺栓塞引起的中风。然而，达比加群对胃肠道黏膜损伤的潜在不良反应常常被忽视，甚至会诱发食管炎。
一名77岁女性因进行性胸骨后疼痛、上腹部不适和吞咽困难症状入院。
食管胃十二指肠镜检查显示食管远端有纵向脱落的黏膜铸型。组织学检查显示鳞状上皮有中性粒细胞浸润、部分上皮变性以及幽门螺杆菌。基于文献回顾、病史和影像学检查，该患者被诊断为达比加群所致食管炎。
患者在未停用达比加群的情况下，通过标准的幽门螺杆菌根除治疗和质子泵抑制剂得以康复。
2周后，胸骨后疼痛和吞咽困难缓解，上腹部不适减轻。
我们的病例强调了医生了解达比加群所致食管炎临床和内镜特征的重要性，以及对于长期接受达比加群治疗的患者进行幽门螺杆菌相关检测及必要时根除治疗的重要性。
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