Pinpoint Localized Odynophagia (PLO) as a Specific Symptom of Pill-induced Oesophagitis (PIO) in the Evaluation of Acute Retrosternal Chest Pain

摘要

Introduction: 36 out of 100 cases of retrosternal chest pains are due to oesophagealpathologies, and Pill-induced Oesophagitis (PIO) is one of them. PIO can present as retrosternal chestpain associated with various Gastrointestinal (GI) symptoms and require a high index of suspicion. PIOis a clinical diagnosis; and oesophagogastroscopy is required for confirmation of the diagnosis, to findout complications of PIO and to rule out other oesophageal disorders. Our aims of the present studywere to study clinical profile, risk factors and endoscopic features of PIO.Materials and Methods: We have done a cross-sectional study of 1000 patients with acute retrosternalchest pain, and all patients of suspected upper gastrointestinal system involvement were subjected tooesophagogastroscopy. Patients having a history of pill ingestion followed by retrosternal chest painwith GI symptoms of less than 10 days duration and having typical endoscopy findings like kissingulcer, multiple small discrete ulcers or erosion of esophagus were diagnosed as PIO after excludingother oesophageal pathologies.Results and Conclusion: Among 1000 retrosternal chest pain patients, 450(45%) cardiovascular,255(25.5%) respiratory, 248(24.85%) upper GI and 47(0.47%) had other system involvement. Among248 GI patients, the frequency of symptoms was as follows: Pinpoint localized odynophagia (8.46%),non-localised odynophagia (12.09%), nausea (62.09%), vomiting (44.35%), dysphagia (3.62%),dyspepsia (13.70%) and hematemesis (0.8%). PLO, dysphagia, and hematemesis were significantsymptoms of PIO (p<0.05). Endoscopic findings suggestive of PIO such as kissing ulcer, multiplesmall discrete ulcers, oesophageal erosions were observed in 91.30%, 47.83%, and 34.78% patients,respectively. Involvement of the middle third of esophagus was present in 74.19% and the lower thirdin 25.81% patients. Most of the patients with PLO had kissing oesophageal ulcer seen on endoscopy (pvalue=0.0002). The habit of consuming pill with less than 100 ml of water and consumption of nightpill dose 10 minutes or less before sleeping were observed as significant risk factors for PIO (pvalue<0.05). PLO is a newly established and highly specific symptom of PIO of our study and itmatches with kissing ulcer of the esophagus by endoscopy.