Bisphosphonate-induced Esophagitis Dissecans Superficialis: A Rare Case Report
Abstract
Abstract: Esophagitis dissecans superficialis (EDS), also referred to as "sloughing esophagitis," is an uncommon benign condition characterized by the desquamation of the superficial layer of the esophageal squamous mucosa. It is often underdiagnosed due to its rarity and nonspecific clinical presentation. Although several factors such as caustic ingestion, thermal injury, autoimmune disorders, and mechanical trauma have been implicated, medication-induced mucosal injury remains one of the most significant causes. Among these, bisphosphonates - a class of drugs widely prescribed for osteoporosis and other bone-related disorders - have been identified as a potential offending agent. We report the case of a 66-year-old woman with no significant comorbidities who presented with persistent retrosternal burning and pain for 2 months. There was no associated dysphagia, odynophagia, vomiting, hematemesis, weight loss, or history of nonsteroidal anti-inflammatory drug use. Physical and systemic examinations were unremarkable. Despite treatment with double-dose esomeprazole for 8 weeks, her symptoms persisted. Upper gastrointestinal endoscopy revealed a large area of whitish sloughed-off mucosa overlying a superficial ulcer with regular margins, extending from 26 cm to just above the gastroesophageal junction. A detailed drug history subsequently revealed the use of bisphosphonate gel for osteoporosis. Histopathological analysis demonstrated sloughed squamous epithelium with the…
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