Novel Endoscopic Therapy for the Treatment of Pill induced Esophageal ulcer

Background and aims; The available therapy for retrosternal pain and dysphagia associated with pill induced esophageal ulcer are only partially effective in relieving symptoms and no specific treatments have been shown to be beneficial in altering the course of medication induced injury. Our aim of the study is to assess the safety and efficacy of endoscopic injection of Lignocaine hydrochloride for the relief of retrosternal pain and dysphagia in cases of pill induced esophageal ulcer(s). Patients and methods; From March 2000 to March 2006, 17 patients of pill induced esophageal ulcer who did not respond to conventional treatment underwent endoscopic injection of Lignocaine hydrochloride using sclerotherapy needle in and around the pill induced esophageal ulcer(s) to relieve retrosternal pain and dysphagia. Relief of retrosternal pain and dysphagia with reference to Visual analogue scale (VAS) score and dysphagia grading respectively were scored by blinded examiners before and after treatment. Results: Of the 17 patients, 15 patients got immediate and complete relief of symptoms after the first session of injection and 2 patients had relief of dysphagia from grade 4 to grade 1-2 after the first session of injection and appreciated complete relief of symptoms (dysphagia grade 0) after the second session of injection given 4 days later the first session of injection. There was significant change in VAS score before and after injection of Lignocaine hydrochloride (p<0.0001). Conclusions: The endoscopic injection Lignocaine hydrochloride in and around the pill induced esophageal ulcer(s) for the relief of odynophagia and retrosternal pain is safe and effective.