Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review
Abstract
:1. Introduction
2. Case Presentation
3. Discussion
- Out of the 30 patients undergoing endoscopy, 21 (70.0%) patients had characteristic features of EDS;
- The histology of esophageal biopsies found a sloughing of the superficial layer of epithelium in all cases, highlighted the presence of eosinophils on the surface in 13.3% of patients, and observed parakeratosis in 56.7% of cases, while 6.7% had normal underlying mucosa;
- All 30 patients had a favorable clinical outcome, with improvements in endoscopic appearance irrespective of acid suppressive therapy with PPIs (30% without PPI treatment, 70% with PPI treatment).
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Lee, S.R.; Choi, E.K.; Kwon, S.; Han, K.D.; Jung, J.H.; Cha, M.J.; Oh, S.; Lip, G.Y.H. Effectiveness and Safety of Contemporary Oral Anticoagulants Among Asians with Nonvalvular Atrial Fibrillation. Stroke 2019, 8, 2245–2249. [Google Scholar] [CrossRef] [PubMed]
- Abraham, N.S.; Noseworthy, P.A.; Yao, X.; Sangaralingham, L.R.; Shah, N.D. Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study. Gastroenterology 2017, 5, 1014–1022. [Google Scholar] [CrossRef]
- Rutherford, O.W.; Jonasson, C.; Ghanima, W.; Soderdahl, F.; Halvorsen, S. Comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in atrial fibrillation: A nationwide cohort study. Eur. Heart J. Cardiovasc. Pharmacother. 2020, 2, 75–85. [Google Scholar] [CrossRef] [PubMed]
- Lee, H.J.; Kim, H.K.; Kim, B.S.; Han, K.D.; Park, J.B.; Lee, H.; Lee, S.P.; Kim, Y.J. Risk of upper gastrointestinal bleeding in patients on oral anticoagulant and proton pump inhibitor cotherapy. PLoS ONE 2021, 6, e0253310. [Google Scholar]
- Khouja, C.; Brunton, G.; Richardson, M.; Stokes, G.; Blanchard, L.; Burchett, H.; Khatwa, M.; Walker, R.; Wright, K.; Sowden, A.; et al. Oral anticoagulants: A systematic overview of reviews on efficacy and safety, genotyping, self-monitoring, and stakeholder experiences. Syst. Rev. 2022, 1, 232. [Google Scholar] [CrossRef]
- Byon, W.; Garonzik, S.; Boyd, R.A.; Frost, C.E. Apixaban: A Clinical Pharmacokinetic and Pharmacodynamic Review. Clin. Pharmacokinet. 2019, 10, 1265–1279. [Google Scholar] [CrossRef]
- Beck, R.N. Oesophagitis dissecans superficialis. Br. Med. J. 1954, 1, 501–502. [Google Scholar] [CrossRef]
- Da Silva, J.R.; Pinho, R.; Ponte, A.; Silva, M.; Furtado, A.; Carvalho, J. Esophagitis dissecans superficialis associated with severe clindamycin toxicity. J. Gastrointest. Liver Dis. 2014, 23, 363. [Google Scholar] [CrossRef]
- Purdy, J.K.; Appelman, H.D.; McKenna, B.J. Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa. Mod. Pathol. 2012, 25, 767–775. [Google Scholar] [CrossRef]
- Zimmer, V.L.; Casper, M.; Lammert, F. Extensive dabigatran-induced exfoliative esophagitis harboring squamous cell carcinoma. Endoscopy 2014, 46, 273–274. [Google Scholar] [CrossRef]
- Forrest, A.; Ali, N.; D’Agostino, R. Esophageal cast (desquamative esophagitis). Abdom. Radiol. 2021, 10, 5050–5052. [Google Scholar] [CrossRef] [PubMed]
- Akhondi, H. Sloughing esophagitis: A not so common entity. Int. J. Biomed. Sci. 2014, 4, 282–286. [Google Scholar] [CrossRef]
- Patil, R.; Sunkara, T.; Ona, M.A.; Gaduputi, V.; Reddy, M. Fungal Esophagitis Presenting with Esophagitis Dissecans Superficialis: Cause or Concurrence? A Diagnostic Conundrum. Gastroenterol. Res. 2016, 9, 108–110. [Google Scholar] [CrossRef] [PubMed]
- Johnston, D.N.; Veettil, R. Oesophagitis dissecans superficialis-an unusual endoscopic finding. Ulst. Med. J. 2020, 1, 39–40. [Google Scholar]
- Lin, S.; Wang, Y.; Zhang, L.; Guan, W. Dabigatran must be used carefully: Literature review and recommendations for management of adverse events. Drug Des. Dev. Ther. 2019, 13, 1527–1533. [Google Scholar] [CrossRef]
- Wang, C.C.; Chen, Y.L.; Lu, T.C.; Lee, C.; Chang, Y.C.; Chan, Y.F.; Mathew, P.; Lin, X.R.; Hsieh, W.R.; Huang, T.Y.; et al. Design and evaluation of oral formulation for apixaban. Heliyon 2023, 8, e18422. [Google Scholar] [CrossRef]
- Paul, T.; Taylor, T.; Babu, R.S.A. Sodium lauryl sulphate. Br. Dent. J. 2019, 227, 1012. [Google Scholar] [CrossRef] [PubMed]
- Qasim, A.; Jyala, A.; Ghazanfar, H.; Baqui, A.; Patel, H. Esophagitis Dissecans Superficialis: Unveiling the Enigmatic Entity of Esophageal Mucosal Sloughing. Cureus 2023, 8, e43549. [Google Scholar] [CrossRef]
- Moawad, F.J.; Appleman, H.D. Sloughing esophagitis: A spectacular histologic and endoscopic disease without a uniform clinical correlation. Ann. N. Y. Acad. Sci. 2016, 1380, 178–182. [Google Scholar] [CrossRef]
- Gayam, S.; Anumandla, A. A Rare Case of Sunitinib-Induced Exfoliative Esophagitis. ACG Case Rep. J. 2016, 3, e155. [Google Scholar] [CrossRef]
- Prasoppokakorn, T.; Panarat, P. First Case of Esophagitis Dissecans Superficialis in an HIV Patient: A Case Report and Literature Review. Case Rep. Infect. Dis. 2019, 2019, 4616937. [Google Scholar] [CrossRef]
- Kanagalingam, G.; Sostre Santiago, V.; Vyas, V.; Manocha, D. Gastrointestinal Hemorrhage from Esophageal Dissecans Superficialis After the Initiation of a Tyrosine Kinase Inhibitor. Cureus 2021, 7, e16471. [Google Scholar] [CrossRef] [PubMed]
- Rokkam, V.R.; Aggarwal, A.; Taleban, S. Esophagitis Dissecans Superficialis: Malign Appearance of a Benign Pathology. Cureus 2020, 6, e8475. [Google Scholar] [CrossRef] [PubMed]
- Iwamuro, M.; Ennishi, D.; Matsuoka, K.I.; Tanaka, T.; Okanoue, S.; Obayashi, Y.; Sakae, H.; Kawahara, Y.; Okada, H. Four Cases of Desquamative Esophagitis Occurring after Hematopoietic Stem Cell Transplantation. Intern. Med. 2020, 59, 3015–3022. [Google Scholar] [CrossRef] [PubMed]
- Zhou, Y.; Dai, Y.; Lu, L.; Fu, Z. Dabigatran-induced esophagitis: A case report. Medicine 2020, 99, e19890. [Google Scholar] [CrossRef]
- Zheng, W.; Zhang, H.; Zhang, X.; Liu, Y. Dermatomyositis with exfoliation of esophageal mucosa: A case report. J. Cent. South Univ. 2021, 46, 104–107. [Google Scholar]
- Hart, P.A.; Romano, R.C.; Moreira, R.K.; Ravi, K.; Sweetser, S. Esophagitis dissecans superficialis: Clinical, endoscopic, and histologic features. Dig. Dis. Sci. 2015, 60, 2049–2057. [Google Scholar] [CrossRef] [PubMed]
- Orosz, E.; Patel, A.V. Sloughing mucosa in esophagitis dissecans superficialis. Clin. Gastroenterol. Hepatol. 2021, 9, A41. [Google Scholar] [CrossRef]
- Jaben, I.; Schatz, R.; Willner, I. The clinical course and management of severe esophagitis dissecans superficialis: A case report. J. Investig. Med. High Impact Case Rep. 2019, 7, 2324709619892726. [Google Scholar] [CrossRef]
- Hurst, K.V.; O’Callaghan, J.M.; Handa, A. Quick reference guide to apixaban. Vasc. Health Risk Manag. 2017, 13, 263–267. [Google Scholar] [CrossRef]
- Nasir, U.M.; Rodgers, B.; Panchal, D.; Choi, C.; Ahmed, S.; Ahlawat, S. Ferrous Sulfate-Induced Esophageal Injury Leading to Esophagitis Dissecans Superficialis. Case Rep. Gastroenterol. 2020, 1, 172–177. [Google Scholar] [CrossRef] [PubMed]
- Salehi, A.M.; Salehi, H.; Hasanzarrini, M. Esophagitis Dissecans Superficialis after COVID-19; A Case Report. Middle East J. Dig. Dis. 2022, 3, 346–348. [Google Scholar] [CrossRef] [PubMed]
- Senyondo, G.; Khan, A.; Malik, F.; Oranu, A. Esophagitis Dissecans Superficialis: A Frequently Missed and Rarely Reported Diagnosis. Cureus 2022, 1, e21647. [Google Scholar] [CrossRef] [PubMed]
- Morel-Cerda, E.C.; Priego-Parra, B.A.; Grube-Pagola, P.; Remes-Troche, J.M. Late-onset ‘sloughing esophagitis’ (esophagitis dissecans superficialis) associated with bullous pemphigoid. BMJ Case Rep. 2020, 13, e235135. [Google Scholar] [CrossRef]
- Benamouzig, R.; Guenoun, M.; Deutsch, D.; Fauchier, L. Review Article: Gastrointestinal Bleeding Risk with Direct Oral Anticoagulants. Cardiovasc. Drugs Ther. 2022, 36, 973–989. [Google Scholar] [CrossRef]
- Tajima, H.; Narasaka, T.; Akutsu, D.; Suzuki, H.; Matsui, H.; Maruo, K.; Yamasaki, H.; Mizokami, Y. The Risks of Exfoliative Esophagitis in Patients with Atrial Fibrillation: A retrospective observational study. Medicine 2020, 99, e21681. [Google Scholar] [CrossRef]
- Ray, W.A.; Chung, C.P.; Murray, K.T.; Smalley, W.E.; Daugherty, J.R.; Dupont, W.D.; Stein, C.M. Association of Oral Anticoagulants and Proton Pump Inhibitor Cotherapy with Hospitalization for Upper Gastrointestinal Tract Bleeding. JAMA 2018, 21, 2221–2230. [Google Scholar] [CrossRef]
- Lamine, H.; Bochra, B.; Mouna, M.; Heykel, E.; Monia, T.; Mohamed Masaddak, A. Esophagitis dissecans superficialis due to severe nonsteroidal anti-inflammatory drugs toxicity. Presse Med. 2018, 47, 695–697. [Google Scholar] [CrossRef]
- Kubisz, P.; Stanciakova, L.; Dobrotova, M.; Samos, M.; Mokan, M.; Stasko, J. Apixaban-Metabolism, Pharmacologic Properties and Drug Interactions. Curr. Drug Metab. 2017, 7, 609–621. [Google Scholar] [CrossRef]
- Hanigan, S.; Das, J.; Pogue, K.; Barnes, G.D.; Dorsch, M.P. The real world use of combined P-glycoprotein and moderate CYP3A4 inhibitors with rivaroxaban or apixaban increases bleeding. J. Thromb. Thrombolysis 2020, 49, 636–643. [Google Scholar] [CrossRef]
- De, S.; Williams, G.S. Esophagitis dissecans superficialis: A case report and literature review. Can. J. Gastroenterol. Hepatol. 2013, 27, 563–564. [Google Scholar] [CrossRef] [PubMed]
Endoscopic Follow-Up | Treatment | Biopsy | Etiology | Patient | Author, Year, [Ref.] |
---|---|---|---|---|---|
Follow-up endoscopy at 1 week (healed) | Liquid diet, iron supplementation was withheld | Yes | Medication-induced esophagitis (oral iron supplementation) | 94-year-old male | Nasir UM et al., 2020 [31] |
Follow-up endoscopy at 1 year (healed) | High-dose proton pump inhibitor | Yes | COVID-19 infection | 68-year-old female | Salehi AM et al., 2022 [32] |
None | Oral diclofenac was discontinued, treated with oral sucralfate and high-dose proton pump inhibitor | Yes | Medication-induced esophagitis (oral diclofenac) | 54-year-old male | Senyondo G et al., 2022 [33] |
None | Oral prednisone | Yes | Autoimmune disease (bullous pemphigoid) | 67-year-old male | Morel-Cerda EC et al., 2020 [34] |
None | Double-dose proton pump inhibitor and sucralfate | Yes | Treatment with tyrosine kinase inhibitor | 70-year-old male | Kanagalingam G et al., 2021 [22] |
None | Oral proton pump inhibitor and sucralfate | No | Treatment with metotrexate | 57-year-old male | Venkata R et al., 2020 [23] |
Follow-up endoscopy at 1 week (healed) | Intravenous proton pump inhibitor | No | Following hematopoietic stem cell transplantation | 18-year-old female, 29-year-old male, 21-year-old male, 16-year-old male | Iwamuro M et al., 2020 [24] |
None | Proton pump inhibitor treatment | Yes | Treatment with dabigatran | 77-year-old women | Zhou Y et al., 2020 [25] |
Follow-up endoscopy at 1 week (healed) | Double-dose proton pump inhibitor | Yes | Treatment with sunitinib | 66-year-old male | Gayam S et al., 2016 [20] |
Yes (healed) | Steroid treatment | Yes | Dermatomyositis | 36-year-old male | Zheng W et al., 2021 [26] |
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Coseru, A.I.; Ciortescu, I.; Nemteanu, R.; Barboi, O.-B.; Floria, D.-E.; Vulpoi, R.-A.; Strungariu, D.G.; Ilie, S.I.; Rosca, V.; Drug, V.-L.; et al. Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review. Diseases 2024, 12, 263. https://doi.org/10.3390/diseases12100263
Coseru AI, Ciortescu I, Nemteanu R, Barboi O-B, Floria D-E, Vulpoi R-A, Strungariu DG, Ilie SI, Rosca V, Drug V-L, et al. Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review. Diseases. 2024; 12(10):263. https://doi.org/10.3390/diseases12100263
Chicago/Turabian StyleCoseru, Alexandru Ionut, Irina Ciortescu, Roxana Nemteanu, Oana-Bogdana Barboi, Diana-Elena Floria, Radu-Alexandru Vulpoi, Diana Georgiana Strungariu, Sorina Iuliana Ilie, Vadim Rosca, Vasile-Liviu Drug, and et al. 2024. "Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review" Diseases 12, no. 10: 263. https://doi.org/10.3390/diseases12100263
APA StyleCoseru, A. I., Ciortescu, I., Nemteanu, R., Barboi, O. -B., Floria, D. -E., Vulpoi, R. -A., Strungariu, D. G., Ilie, S. I., Rosca, V., Drug, V. -L., & Plesa, A. (2024). Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review. Diseases, 12(10), 263. https://doi.org/10.3390/diseases12100263