Oesophageal damage oesophageal injury can occur due to

Oesophageal
damage

oesophageal injury can occur due to the adhesion of dosage
form releasing concentrated solution of drug to a very small area of mucosa.Dysphagia
is the result of repeated insult to the mucosa; and even rebuke formation, both
of them intensify the original problem. Enteric coated formulations given as an
alternative of gastric mucosal irritant drug can result into the failure if
units chalet into the oesophagus having pH near in 19701, first medication
induced oesophageal injury was  reported
and in 198323 it was reviewed.

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Afterall there have been numerous reports in the literature,
due to 26 different medications 221 cases were reported in the time period
between 1960 and 1983.

Numerous drugs like emepronium bromide, theophylline,
doxycycline monohydrate and bisphosphonates26 
have been reported as to account for half of the reported cases
including antibiotics, regardless of brand. Although this has not been studied
but various proportion of drugs which are prescribed may be reflected through
it . According to endoscopic surveillance studies in healthy volunteer we can
detect oesophagitis in 20% of subjects having non-steroidal anti-inflammatories
(NSAIDs). Oesophageal stricture can be caused in patients with gastro-oesophageal
reflux due to NSAIDs caustic or acidic effects, hyperosmotic effect, heat
production, gastro-oesophageal reflux, impaired oesophageal clearance of acid
and accumulation within the basal layer of the epithelium are the range of
mechanisms through which drug can cause local injury, moreover to other toxic
effects caused by the drug.

Physiological
Pharmaceutics

An erosion about the size of a coin,  a deep ulcer or redness and friability of
mucosa are determined by endoscopy. Sometimes particles of the drug get adhered
to the mucosa.The aortic arch or slightly above it is the area where majority
of abrasion are located. mostly  in
bedridden patients, lesions are found higher in oesophagus the lower third of
the oesophagus, just above the gastro-oesophageal junction is the area where
lesions have also been reported. stricture may result in severe cases. There
are many patients that are ostensibly healthy but suddenly hit by the symptoms
of oesophageal injury. Such patients are between 9 and 98 years of age, both
men and women alike are affected according to the literature.

If the patient takes the tablets/capsules without water and
just  before retiring to bed, this single
dosage form can cause problems. This results in severe retrosternal pain after
waking up few hours later or inmorning and it cant be reassured by drinking or
eating. As swallowing becomes painful, patient avoids it.In this situation
doctor will avert  the heart disease and
prescribe an analgesic or antacid, if medical approach is made .This can only
rissolve when the patient  changes his
method of taking medications otherwise pain will continue.

 

EFFECT
OF AGEING

In ageing population, one of the major health care problem
with advancing age is loss of the ability to swallow. Radiological studies
shows the presence of a normal pattern of of deglutition in only 16%
individuals out of 56 patients with a mean age 83 years . 63% of the cases were
noted having Oral abnormalities, such as having trouble in controlling and
transporting  a bolus followed by
ingestion to the oesophagus. Although minor changes of structure and function
are directly related to ageing, however neoplasms, strictures and diverticula
are structural abnormalities that cause oesophageal dysphagia therefore, during
a swallow trouble occurs in relation with the coordination of tongue,
oropharynx and upper oesophagus associated with neurological mechanisms.

Oesophageal
transit

Even small tablets (4 mm) get adhered to the oesophagus as a
result of weakened swallowing in elderly.According to reports aminobisphosphonates
which is  used to inhibit bone
resorption, along with the other low dose tablets are cause of ulceration.Such
medications should be consumed with 240 ml water and after administration the
subject should remain vertical for 30 minutes as according to FDA
recommendation. By sticking on the roof of oropharynx, coadministered dosage
forms which float on the water can also present problems to the elderly.

PATIENT
PREFERENCE AND EASE OF SWALLOWING

Due to smooth surface and shape which support swallowing,
Patients prefer to take capsules rather than large oval or round tablets
comparatively. After the age of 60 years when up to 60% of healthy subjects may
show  a problem, the difficulty rate to
swallow large round tablets increases. There is a tendency amongst these
patients have tendency either  to open
the capsule and dissolve the pills in food or a drink or to chew tablets and
capsules. Due to this there is an unknown loss of dose amount. Sustained or
controlled release formulations that are designed to be swallowed complete are
effected by chewing formulations and also the integrity of any surface coating
is destroyed by chewing formulations. Surface area available for drug
termination is increased by chewing and it also destroy matrix structures.

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