Portal de Periódicos da CAPES

NACHOS Induced Panesophageal Ulcers

2009; Lippincott Williams & Wilkins; Volume: 104; Linguagem: Inglês

10.14309/00000434-200910003-01054

1572-0241

Deerajnath Lingutla, Mohammad Titi, Ankit Rohatgi, Tarun Kothari,

Tracheal and airway disorders

Purpose: Introduction: Several uncommon etiologies including medications, foreign bodies and systemic causes were reported in the past for esophageal ulcers. None have reported ulceration involving the entire esophagus secondary to food ingestion. We report a rare occurrence of panesophageal ulcers secondary to excessive ingestion of unchewed NACHOS. Case report: A 28 year old male presented with complaints of dysphagia and odynophagia for last 4 days. He described razor like pain in the chest on swallowing, even saliva. He denied any gastrointestinal symptoms in the past or any recent medication use. He admitted to excessive ingestion of NACHOS without proper chewing one day prior to the onset of current symptoms. Physical examination was normal. Esophagogastroduodenoscopy (EGD) revealed multiple severe deep circumferential, discrete ulcers with marked inflammation involving the entire length of esophagus, with normal appearance of stomach and duodenum. Several biopsies were taken from proximal to distal esophagus which showed inflammation with no evidence of malignancy, viral or other infectious etiology. He was treated with combination of proton pump inhibitors, Mylanta®, lidocaine and Donnatal®. His symptoms were resolved within one week and a repeat EGD in 4 weeks demonstrated healing of 90% of panesophageal ulcers with scarring. Discussion: The risk factors for damage to esophageal mucosa include pre existing esophageal disorders like gastroesophageal reflux disease, hiatal hernia, achalasia, esophageal strictures; foreign body ingestion; medications like antibiotics, NSAIDS and bisphosphonates. Our patient is a healthy young individual without any of above risk factors. Esophageal mucosal damage secondary to food or pill ingestion usually occurs at the aortic arch level or above the lower esophageal sphincter, which are physiological narrowings. We are unsure about the mechanism by which NACHOS caused panesophageal ulceration in our patient. We propose that the excessive physical contact of unchewed NACHOS with already fragile epithelial lining of his esophagus may have caused the extensive ulcerations.Figure: NACHOS induced deep esophageal ulcers.