Alendronate-associated esophageal injury: Pathologic and endoscopic features

Susan C. Abraham, Marcia Cruz-Correa, Linda A. Lee, John H. Yardley, Tsung Teh Wu

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Ingestion of alendronate sodium (Fosamax) by osteoporotic patients can be associated with esophagitis and esophageal ulcer. Alendronate can damage the esophagus both by toxicity from the medication itself and by nonspecific irritation secondary to contact between the pill and the esophageal mucosa, similar to other cases of 'pill esophagitis'. Despite its wide use, the histologic appearances of alendronate-associated esophageal ulceration have not been previously described in detail, nor is this type of medication- induced injury commonly appreciated by pathologists when evaluating biopsies from ulcer sites. We report a series of 10 patients who experienced erosive/ulcerative esophagitis while ingesting alendronate, and describe the associated endoscopic and pathologic features. Biopsies from all patients showed inflammatory exudate and inflamed granulation tissue as characteristic of any ulcer site. Polarizable crystalline foreign material was present in six of 10 biopsies (60%). Multinucleated giant cells within the inflammatory exudate were present near this crystalline foreign material in three of 10 biopsies (30%). Adjacent squamous epithelium typically showed active inflammation and a reactive appearance with enlarged, hyperchromatic nuclei. Multinucleated squamous epithelial giant cells were present in two of 10 cases (20%). Microorganisms were unusual; scattered fungi and/or viral inclusions were present in only two of 10 biopsies (20%). Recognition of alendronate-associated erosive or ulcerative esophagitis, particularly in postmenopausal women, and communication of this possibility to the clinician can improve patient care.

Original languageEnglish (US)
Pages (from-to)1152-1157
Number of pages6
JournalModern Pathology
Volume12
Issue number12
StatePublished - Dec 1999
Externally publishedYes

Fingerprint

Alendronate
Esophagitis
Wounds and Injuries
Biopsy
Ulcer
Exudates and Transudates
Giant Cells
Granulation Tissue
Esophagus
Patient Care
Fungi
Epithelium
Eating
Epithelial Cells
Communication
Inflammation

Keywords

  • Alendronate
  • Esophagitis
  • Esophagus
  • Fosamax
  • Pathology
  • Pill
  • Ulcer

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Abraham, S. C., Cruz-Correa, M., Lee, L. A., Yardley, J. H., & Wu, T. T. (1999). Alendronate-associated esophageal injury: Pathologic and endoscopic features. Modern Pathology, 12(12), 1152-1157.

Alendronate-associated esophageal injury : Pathologic and endoscopic features. / Abraham, Susan C.; Cruz-Correa, Marcia; Lee, Linda A.; Yardley, John H.; Wu, Tsung Teh.

In: Modern Pathology, Vol. 12, No. 12, 12.1999, p. 1152-1157.

Research output: Contribution to journalArticle

Abraham, SC, Cruz-Correa, M, Lee, LA, Yardley, JH & Wu, TT 1999, 'Alendronate-associated esophageal injury: Pathologic and endoscopic features', Modern Pathology, vol. 12, no. 12, pp. 1152-1157.
Abraham SC, Cruz-Correa M, Lee LA, Yardley JH, Wu TT. Alendronate-associated esophageal injury: Pathologic and endoscopic features. Modern Pathology. 1999 Dec;12(12):1152-1157.
Abraham, Susan C. ; Cruz-Correa, Marcia ; Lee, Linda A. ; Yardley, John H. ; Wu, Tsung Teh. / Alendronate-associated esophageal injury : Pathologic and endoscopic features. In: Modern Pathology. 1999 ; Vol. 12, No. 12. pp. 1152-1157.
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