Dabigatran-induced esophagitis

Abstract

Abstract Rationale: Dabigatran is an anticoagulant medication that has been widely used to prevent strokes caused by atrial fibrillation, deep vein thrombosis, and pulmonary embolism. However, the potential adverse effect of dabigatran of gastrointestinal mucosal injury is often neglected, and even induces esophagitis. Patient concerns: A 77-year-old woman was admitted to the hospital with symptoms of progressive retrosternal pain, upper abdominal discomfort, and dysphagia. Diagnosis: Esophagogastroduodenoscopy showed longitudinal sloughing mucosal casts in the distal esophagus. Histological examination showed squamous epithelium with neutrophil infiltration, partial epithelial degeneration, and Helicobacter pylori. Based on a literature review, medical history, and imaging examination, the patient was diagnosed with dabigatran-induced esophagitis. Interventions: The patient recovered with standard H. pylori eradication therapy and proton pump inhibitor without discontinuing dabigatran. Outcomes: After 2 weeks, the retrosternal pain and dysphagia were relieved and upper abdominal discomfort was attenuated. Lessons: Our case highlights the importance of physicians’ awareness of the clinical and endoscopic characteristics of dabigatran-induced esophagitis and the importance of H. pylori-associated tests and eradication if necessary for patients with long-term dabigatran treatment.