NSAID-induced pyloric stenosis leading to oesophageal intramucosal dissection. (19th May 2016)

• Record Type: Journal Article
• Authors: Tey, Kai Rou; Kemmerly, Thomas; Banerjee, Bhaskar
• Is Part Of: BMJ case reports. Volume 2016
• Publication Date: 2016-05-19
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2016-215777
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : We describe a rare case of a 75-year-old woman with significant non-steroidal anti-inflammatory drug (NSAID) use who presented with haematemesis. Upper endoscopy revealed a large (9 cm) intramucosal dissection of the oesophagus without extension into the gastro-oesophageal junction and a severely narrowed pylorus. We postulate that she developed pyloric stenosis due to peptic ulcer disease from chronic NSAID use. This then led to gastro-oesophageal reflux. Undigested pills in the refluxate had contacted oesophageal mucosa, leading to pill-induced oesophageal injury. This, along with vomiting, is postulated to have led to the oesophageal intramucosal dissection. She improved with conservative medical management with a clear liquid diet and proton pump inhibitors, and a follow-up upper endoscopy 1 week later showed recovery of the previously seen intramucosal dissection.