Very Late-Onset Dabigatran-Induced Esophageal Injury.

An 87-year-old man with persistent atrial fibrillation experienced heartburn and dysphagia at 2 years 9 months after initiation of dabigatran. An esophagogastroduodenoscopy demonstrated multiple longitudinal white plaques with ulcers in the narrowed midesophagus compressed between the left atrium and the tortuous aorta. We speculate that the esophageal stenosis contributed to stasis of dabigatran within the esophagus, resulting in prolonged mucosal contact with the caustic contents of the drug. Progressive enlargement of the left atrium may have led to the late onset of the potentially serious complication.