Oral contraceptive-induced esophageal ulcer. Two cases and literature review

Estrogen and its role in gastrointestinal health and disease

INTRODUCTION

While the concept of a role of estrogen in gastrointestinal (in particular, colonic) malignancy has generated excitement in recent years, no review has examined the role of this potent and omnipresent steroid hormone in physiological states or its contribution to the development of benign pathological processes. Understanding these effects (and mechanisms therein) may provide a platform for a deeper understanding of more complex disease processes.

METHODS

A literature search was conducted using the PubMed database and the search terms were "estrogen," "estrogen AND gastrointestinal tract," "estrogen AND colon," "estrogen AND esophagus," "estrogen AND small intestine," "estrogen AND stomach," "estrogen AND gallbladder," and "estrogen AND motility." Bibliographies of extracted studies were further cross-referenced. In all, 136 full-text articles were selected for review. A logical organ-based approach was taken to enable extraction of data of clinical relevance and meaningful interpretation thereof. Insight is provided into the hypotheses, theories, controversies, and contradictions generated over the last five decades by extensive investigation of estrogen in human, animal, and cell models using techniques as diverse as autoradiographic studies of baboons to human population analysis.

CONCLUSIONS

Effects from esophagus through to the colon and rectum are summarized in this first concise collection of data pertaining to estrogenic actions in gastrointestinal health and disease. Mechanisms of these actions are discussed where possible. Undoubtedly, this hormone exerts many actions yet to be elucidated, and its potential therapeutic applications remain, as yet, largely unexplored.

Role of alpha-2 adrenergic receptors in anti-ulcer effect mechanism of estrogen and luteinising hormone on rats

OBJECTIVE

To evaluate anti-ulcer effect of estrogen and luteinising hormone (LH) on indomethacin-induced ulcer model in female rats.

STUDY DESIGN

Ovariectomy in healthy adult famale rats. Acute administration of estradiol to ovariectomised rats. Acute administration of LH to intact rats. Combined administration of tamoxifen with estradiol or LH to intact rats. Combined administration of yohimbin with estradiol or LH to intact rats. Combined administration of piperoxan with estradiol or LH to intact rats. Indomethacin administration to all rats.

RESULTS

Results have shown that LH exerted anti-ulcer activity at all doses we used but estradiol at 5 and 10 mg/kg. In rats administered yohimbine and piperoxan estradiol and LH could not prevent indomethacin-induced ulcers. In rats administered tamoxifen, estradiol and LH could prevent indomethacin-induced ulcers.

CONCLUSIONS

LH is a very potent endogen anti-ulcer factor, and the anti-ulcerative activities of estrogen and LH are mediated via alpha-2 adrenergic receptors, but not es receptors. The resistance of gastric mucosa to aggressive factors may decrease as a result of LH inhibition when estrogen is secreted chronically in the human body.

Cyproterone acetate and ethinylestradiol-induced pill oesophagitis: a case report

Although there are many cases of oesophagitis related to pill in medical literature, there are only a few reports concerning oesophagitis related to oral contraceptives, and none about cyproterone acetate and ethinylestradiol combination (Diane-35). In this report, we describe a female patient who suffered from odynophagia and retrosternal pain after taking Diane-35 for hirsutism. The endoscopic examination revealed two well-demarcated circumferential ulcers of 1 cm diameter surrounded by relatively normal mucosa in mid-oesophagus. The patient had gone to bed immediately after taking the pill. Oral intake was stopped, and intravenous fluids and omeprazole were administered as part of treatment. The patient benefited from this approach very quickly and was discharged from hospital in 5 days. The oesophagus was completely normal in control endoscopy after 2 months. Diane-35 should be added to the list of drugs causing pill oesophagitis, and physicians should inform the patients that the pills should be taken with enough water and they should not lie down right after ingesting the pills.

Pill-induced esophagitis caused by oral rifampin

OBJECTIVE

To report a case of pill-induced esophagitis caused by oral rifampin.

DATA SOURCES

English-language references identified via a MEDLINE search from January 1966 to May 1998 and a bibliographic review of pertinent articles.

DATA SYNTHESIS

A large number of oral medications have been reported to cause pill-induced esophagitis. This case represents the second report attributed to rifampin. A 70-year-old white man receiving vancomycin, gentamicin, and oral rifampin for treatment of Staphylococcus epidermidis prosthetic valve endocarditis reported dysphagia immediately after swallowing a rifampin capsule on the fourth day of therapy. The following day, fiberoptic laryngoscopy and esophagoscopy demonstrated a red capsule partially embedded in the neopharynx. A day later, upper esophageal obstruction consistent with edema related to pill-induced esophagitis was identified by barium swallow. Following the procedure, the patient was placed on total parenteral nutrition and took nothing by mouth. Sixteen days after first reporting dysphagia, he was placed on a full liquid diet. Several factors may have increased the patient's risk for pill-induced esophagitis, including age, bedridden state, gastroesophageal reflux disease, simultaneous administration of several medications, and neopharyngeal stricture.

CONCLUSIONS

Oral rifampin may cause esophagitis. Healthcare providers should be alert to the possibility of pill-induced esophagitis in susceptible patients. Patients with predisposing factors for the development of pill-induced esophagitis should be educated about proper swallowing of oral medications.