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Oesophagitis: case report A 77-year-old man developed oesophagitis during treatment with doxycycline and aspirin. The man presented to an emergency department with a two days history of severe, persistent epigastric and retrosternal pain; and a one-day history of dysphagia for liquids and solids. In the week before the hospitalisation, he had experienced coryza and dry cough. Three days before the presentation, he had been prescribed with oral doxycycline [dosage not stated]. He managed to take only two tablets before initiation of the symptoms. Three weeks before the presentation, he had been diagnosed with mild gastro-oesophageal reflux and non-STelevation acute coronary syndrome and had started receiving low-dose aspirin 100 mg/day [route not stated], ticagrelor, ramipril, atorvastatin and metoprolol. An examination showed mild epigastric abdominal tenderness and he was unable to drink water, due to regurgitation within 30 seconds of swallowing. A CT chest scan showed lower oesophageal thickening and obstruction of the lumen. Endoscopy demonstrated a 10cm, ulcerated, longitudinal, mass that occupied half of the lumen and desquamated oesophageal mucosa. A biopsy showed doxycycline-induced non-specific oesophagitis without eosinophils. The man’s doxycycline treatment was discontinued, and he was treated with esomeprazole. Eventually, he was able to tolerate solid food and fluids. He was discharged with a prescription of esomeprazole for two months along with all other previous medicines including aspirin. Six weeks later, an endoscopy showed normal oesophagus. Author comment: "We therefore made a diagnosis of severe doxycycline-induced oesophagitis". "Doxycycline and non-steroidal anti-inflammatory medications are the most common culprits." Apostolov R, et al. A difficult pill to swallow: drug-induced oesophagitis. Lancet 394: 1764, No. 10210, Nov 2019. Available from: URL: http://doi.org/10.1016/ 803438191 S0140-6736%2819%2932565-6 - Australia

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Reactions 7 Dec 2019 No. 1782