We report a case of an esophageal ulcer that mimicked advanced esophageal cancer in
a patient who was on alendronate sodium treatment.
A 56-year-old woman presented with progressively worsening pain on swallowing. For
the past 6 months she had been taking 5 mg/day alendronate sodium (Bonalon) for the
treatment of postmenopausal osteoporosis. Upper gastrointestinal endoscopic examination
revealed an ulcerative lesion in the lower esophagus that resembled an advanced esophageal
cancer (Figure [1]). The ulcer’s mucosa was normal, but the ulcer bed was uneven and would not stain
with Lugol dye. Biopsy specimens of the ulcer bed showed a marked infiltration of
neutrophils and eosinophils in the subepithelial space, but no signs of malignancy
(Figure [2]). We stopped the alendronate sodium and prescribed a proton-pump inhibitor. Endoscopic
examination 2 months later showed marked improvement in the ulcer, with no esophageal
stricture.
Figure 1 Endoscopic image of the lower esophagus showing an ulcerative lesion mimicking advanced
esophageal cancer.
Figure 2 Histopathological examination of a biopsy specimen taken from the ulcer bed revealed
a marked infiltration of neutrophils and eosinophils in the subepithelial space.
This is the first report, to the best of our knowledge, of an alendronate-induced
esophageal ulcer mimicking advanced esophageal cancer. Alendronate sodium, a bisphosphonate
that inhibits osteoclast activity, is principally used to prevent and treat osteoporosis
and is generally considered to be well tolerated. One multinational, randomized, double-blind
study, in which postmenopausal women with osteoporosis were treated with alendronate
for up to 10 years, concluded that the drug’s adverse effects on the upper gastrointestinal
tract were similar to those of placebo [1]. However, several previously reported cases of severe esophagitis and perforation
of the esophagus suggest that adverse effects of alendronate might be more common
than is sometimes recognized [2].
We should be aware of the possibility of esophageal lesions resulting from the use
of bisphosphonates in patients with osteoporosis. If a patient taking alendronate
presents with acute-onset dysphagia or heartburn, an upper gastrointestinal endoscopic
examination should be considered in order to exclude ulceration.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AZ
