DR CHRIS MOGEKWU

Doxycycline is a widely prescribed tetracycline antibiotic with known gastrointestinal adverse effects, including pill-induced oesophagitis and oesophageal ulceration.1 Pill-induced oesophagitis is an inflammatory injury of the oesophageal mucosa caused by prolonged contact of an orally administered medication with the oesophagus, often due to inadequate water intake or lying down soon after swallowing, leading to local irritation or ulceration.2 Frequently implicated drug groups include Antibiotic, Bisphosphonates, Non-Steroidal Anti- Inflammatory Drugs (NSAIDs), Iron Tablets and Potassium Chloride.10 Such reactions have been reported even after a single dose.3 A recent review suggested that athletes consume oral antibiotics, such as Doxycycline, nearly twice as often (2.7% vs 1.3%) as non-athlete populations reflecting higher healthcare consultation rates for respiratory symptoms and a tendency towards precautionary prescribing to minimise training disruption, even when bacterial infection Figure 1a and 1b: Showing endoscopic two opposing (“kissing”) ulcers in the mid- oesophagus consistent with doxycycline induced oesophagitis. is unconfirmed.4 Although adverse reactions such as upper gastrointestinal injury are well documented in the general population, no published case reports have described doxycycline-induced oesophageal ulceration in elite athletes. This case report therefore highlights a rare but clinically important complication in a professional sporting context.