Zenker's diverticulitis secondary to alendronate ingestion: a rare cause of recurrent dysphagia

• Published in: Gastrointestinal endoscopy Vol. 73; no. 2; pp. 368 - 370
• Main Authors: Sharma, Rajiv, MBBS, DeCross, Arthur J., MD, AGAF
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.02.2011; Elsevier
• Subjects: Administration, Oral; Aged; Alendronate - administration & dosage; Alendronate - adverse effects; Biological and medical sciences; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - adverse effects; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Diagnosis, Differential; Digestive system. Abdomen; Diverticulitis - chemically induced; Diverticulitis - diagnosis; Endoscopy; Endoscopy, Gastrointestinal; Esophagus; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Other diseases. Semiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Zenker Diverticulum - chemically induced; Zenker Diverticulum - diagnosis; Zenker's diverticulum; ZD; Relapse; Antiosteoporotic; Esophageal disease; Antiresorptive agent; Diphosphonic acid derivatives; Bisphosphonates; Alendronic acid; Antiosteoclastic agent; Diverticulitis; ENT disease; Digestive diseases; Intestinal disease; Dysphagia
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.10.043

Objective Acute dysphagia/odynophagia developed in a 79-year-old female patient secondary to what we believe was a caustic injury to a large Zenker's diverticulum (ZD) in the setting of long-term alendronate use. She reported severe dysphagia and odynophagia of 1-week duration. She had experienced a similar episode 10 months earlier that had resolved after stopping alendronate temporarily. Although she was able to handle secretions, she was unable to swallow solids or liquids. She was noted to be dehydrated. On endoscopy, a large and markedly inflamed ZD was identified. There was no visual esophageal mucosal injury within the esophagus. Alendronate therapy was discontinued, and parenteral nutrition and proton pump inhibitors were initiated. Her symptoms resolved within 1 week, and she was able to resume oral intake. Design Case report. Setting University Hospital. Limitations Case report. Discussion Bisphosphonate therapy is commonly used to treat osteoporosis and is therefore an increasingly prevalent component of the medication list of elderly patients. These medications may cause significant caustic injury and are therefore administered with strong caution in the setting of dysphagia or known structural abnormalities of the esophagus. The fear is that tablets may become entrapped within a diverticulum and lead to intense acute inflammatory changes. Conclusions Health care providers should be aware of potential complications with ulcerogenic medications in patients with ZD. These medications should be administered with caution in the setting of dysphagia or known structural abnormalities of the esophagus. When patients with history of dysphagia are evaluated for their suitability to receive oral bisphosphonate therapy, care should be taken to investigate the etiology of dysphagia. Evaluation should focus not only on the tubular esophagus, but also on excluding a Zenker's pharyngeal diverticulum with appropriate contrast imaging.