Non-vitamin K anticoagulants (NOAC), also known as direct oral anticoagulants (DOAC) are now commonly used for a variety of conditions requiring chronic anticoagulation. The dabigatran pellets are covered with a tartaric acid core. This strong acid may result in squamous epithelial damage with ensuing exfoliative esophagitis. Elderly patients are more prone to suffer esophageal damage due to medications as they have a) decreased salivary production, b) may not drink enough fluids and c) often have esophageal dysmotility. All these factors contribute to prolonged contact of medications with the esophageal mucosa.
Other important causes of exfoliative esophagitis are: Herpes simplex Virus infection (A), esophagitis dissecans superficialis due to medications(biphosphonates, dabigatran, sunitinib) (B, C), graft-versus-host disease(GVHD), amyloidosis, pemphigus vulgaris.