A CASE OF DABIGATRAN-INDUCED ESOPHAGITIS OBSERVABLE FOR FOUR YEARS, UNTIL SUDDEN DETRIORATION

<p>A 77-year-old woman was prescribed dabigatran 110 mg twice daily for atrial fibrillation. Endoscopy performed six months after starting dabigatran administration, revealed mild esophageal erosion in the mid-esophagus, and at seven months she occasionally had a feeling as if something was stuck in her throat and she also experienced intraoral discomfort. Endoscopy performed two years after starting dabigatran administration, revealed moderate esophageal erosion, and the famotidine she was taking was switched to esomeprazole magnesium hydrate. However, the throat discomfort persisted. Four years after starting dabigatran administration, endoscopy revealed moderate erosion in the mid-esophagus, similar to the finding in prior examinations. Three months later, endoscopy showed longitudinal, thick, white, membrane-like substances in the mid-esophagus. Repeat endoscopy performed three months later showed the same findings and a biopsy specimen revealed esophageal mucosal coagulation necrosis. </p><p>Dabigatran was discontinued and she was switched to apixaban. Her symptoms disappeared 2-3 days later. Two months later, endoscopy showed remarkable improvement in the esophageal mucosa, which appeared nearly normal.</p><p>In this case, although dabigatran was co-administered with proton pump inhibitors and was taken with sufficient water, marked deterioration of endoscopic findings was documented four years after starting dabigatran. During the clinical course, her subjective symptoms were only mild throat and oral discomfort, which are not typical of esophagitis.</p><p>In patients receiving dabigatran treatment, periodic endoscopic examinations are necessary irrespective of whether or not subjective symptoms are present. When admitting esophagitis patients to the hospital, it is considered best to stop dabigatran and switch the patients to another medication.</p>