Esophageal Mucosal Injuries From Drugs, Radiation, and Caustic Agents

Abstract

Various factors can lead to esophageal mucosal injury. A thorough patient history is crucial to accurately diagnose esophageal injuries caused by drugs, radiation, and caustic agents. These conditions are often identifiable based on characteristic clinical features, concomitant diseases, and endoscopic findings and do not necessarily require histological confirmation through biopsies. Regardless of the underlying cause, avoiding or minimizing the offending agent is essential for preventing further mucosal damage. In cases where this is unavoidable, such as radiationinduced esophageal injuries, careful adjustment of the radiation dose, field, and frequency is necessary. Additionally, the use of mucosal protective agents and adherence to a soft diet can help regenerate the mucosal epithelium. Esophageal mucosal injuries can cause chronic complications, such as esophageal strictures; therefore, they require close monitoring. Notably, injuries induced by caustic agents carry an increased risk of progression to esophageal cancer, underscoring the importance of long-term surveillance.

Keywords: Caustics; Chemically-induced disorders; Esophagitis; Gastrointestinal endoscopy; Radiation injuries.

Fig. 1.

Endoscopic findings of drug-induced esophageal mucosal injuries. A: A 64-year-old male with rectal cancer who had discontinued FOLFOX chemotherapy due to severe neuropathy underwent esophagogastroduodenoscopy (EGD), revealing sloughing esophagitis. The patient reported only mild odynophagia. B: A 72-year-old female with dysphagia underwent EGD. She had been taking multiple medications for underlying conditions, including hypertension, diabetes, cardiovascular disease, and arthritis.

Fig. 2.

Endoscopic findings of radiation-induced esophageal mucosal injuries. A 72-year-old female with esophageal squamous cell carcinoma (cT2–3N1) underwent esophagogastroduodenoscopy due to severe chest pain following neoadjuvant concurrent chemoradiotherapy (45 Gy over five weeks). A: Edema, erythema, and erosions were observed throughout the esophagus. B: Tumor size had decreased; however, ulcers, ulcer scars, and friable mucosa were noted around the lesion.

Fig. 3.

Endoscopic findings of esophageal mucosal injuries from caustic agents. A: Zagar Grade 1: a 42-year-old asymptomatic male presented after alkali ingestion. Esophagogastroduodenoscopy (EGD) revealed mild mucosal edema and erythema. B: Zargar Grade 2A: a 20-yearold female underwent EGD immediately after acid ingestion, which revealed friability, hemorrhages, and erosions. C: Zargar Grade 2B–3A: a 57-year-old male presented to the emergency room after ingesting 10% hydrochloric acid in a suicide attempt. EGD showed multiple ulcers and areas of necrosis. D: Zargar Grade 3B: gastric findings from EGD following ingestion of a large volume of acid revealed extensive mucosal necrosis.