Hameed, T A

Khan, A H

Rana, T A

Rao, N

Rizvi, I H

Shaikh, Y M

English

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eCommons@AKUDepartment of Radiology Medical College, PakistanSeptember 1993Phyllocontin (theophylline) induced esophagitisY M. ShaikhAga Khan UniversityA H. KhanAga Khan UniversityN RaoAga Khan UniversityI H. RizviAga Khan UniversityT A. HameedAga Khan UniversitySee next page for additional authorsFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationShaikh, Y. M., Khan, A. H., Rao, N., Rizvi, I. H., Hameed, T. A., Rana, T. A. (1993). Phyllocontin (theophylline) induced esophagitis.Journal of Pakistan Medical Association, 43(9), 183.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/242AuthorsY M. Shaikh, A H. Khan, N Rao, I H. Rizvi, T A. Hameed, and T A. RanaThis report is available at eCommons@AKU: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/242Phylloconfin (Theophylline) induced EsophagitisPages with reference to book, From 183 To 183 Younus M. Shaikh, A. Haleem Khan, I. Hussain Rizvi, TariqA. Hameed, Tauqir A. Rana ( Department of Radiology, TheAga Khan University Hospital, Stadium Road, Karachi. ) Najmussaqib Rao ( Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi. ) Drug ingestion esophagitis has been a well documented phenomenon1-4. A large number o, drugs havebeen implicated, both in solid and liquid forms. The inflammatory process ranges from shallowulceration to fibrosis and stricture formation3. A case of phyllocontininduced acute esophagitis ispresented with radiologic/endoscopic correlation. The only other case on record occurred due toingestion of theophylline without water5.Case Report A 28 years old male presented with pain and difficulty in swallowing solids for the past ten days. Hewas a known asthmatic taking phyllocontin and ventide inhaler. He stopped taking phyllocontin afterthe onset of present symptoms. He was a non- smoker and non-alcoholic and denied aspirin ingestion.He also denied ever taking tablets without water. Double contrast examina tion showed irregular andslightly serrated ulcerative lesions on opposing surfaces of the right and left walls of the esophagus atthe subcarinal level. The right sided lesion measured 2 cm in length. The other measured 1 cm (Figure).Endoscopy showed, at 32 cm. from the incisor teeth, two ulcerated areas, one 1.5 and the other 0.5 cmin length on opposite walls of the esophagus. Rest of the esophageal mucosa looked normal. Stomachand duodenum were nonnal. The ulcers healed on their own in 4 weeks as confirmed on subsequentendoscopy.Discussion Various mechanisms have been described for ulcer formation in the esophagus due to ingested drugs2,3.A variety of drugs like tetracycli e, ferrous sulphate, ascorbic acid, quinidine, potassium chloride andemerpronium have been implicated. Theophylline is known to cause increased gastric add output andincreased incidence of gastroesophageal reflux5. However, i our case the ulcers were higher up thanwould be expected due to reflux esophagitis alone. These were discrete lesions at about mid esophaguswith a totally normal mucosa distally and proximally, both by barium swallow and endoscopicevaluation. Ulcers on the opposite walls and at the same level can be termed “Kissing Ulcers” and mustalert the radiologist to the possibility of drug induced esophagitis. Hence it is postulated thattheophylline may cause ulceration by direct chemolysis of the mucosal covering of the esophagus.References 1. Enzenauer, R.W., Baa,, J.W., McDonnel, J.T. Esopohageal ulceration associated with oraltheophylline (letter to editor). N. Engl.J. Med., 1984;310:261.2. Teplick, 3.0., Teplick, S.K., Ominaky, 5.H., Haskin, ME. Eaophagitis caused by oral medication.Radiology 1980;134:23-25.3. Creteur, V., Laufer, I., Kressel, H.Y. et al. Drug-induced eaophagitis detected by double-contrastradiography. Radiology, 1983; 147: 365-68.4. Bova, 3.0., Dutton, N.E., Goldstein, H.M. and l-loberman, Li. MedicatIon induced esophagitis;diagnoais by doublecontrast esophography. A.J.R., 1987;148:731-32.5. Bengtason, U., Sandberg, N., Bake, B. et al Gaatro-oeaophageal reflux and night-time aathma.Lancet, 1985;1:1501-02.

Phyllocontin (theophylline) induced esophagitis

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Phyllocontin (theophylline) induced esophagitis

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