Garlic-induced esophagitis and gastroenteritis: A review of four cases

Abstract

Garlic, or Allium sativum, is a common culinary ingredient used as a natural medicine for hypertension, hyperlipidemia, cancer prevention, treatment of fungal infection, and atherosclerosis prevention.  We reviewed all cases of garlic-induced esophagitis and gastroenteritis available in academic literature.  A literature search using combinations of the MeSH headings “garlic”, “allium sativum”, “esophagitis”, and “deglutition disorders” was conducted in the Medline, Embase, and PubMed computer databases. References involving reports of esophagitis and gastroenteritis were retrieved. Additional relevant articles were found by analyzing the references provided within the retrieved articles. Our review uncovered four published case reports of garlic-induced esophagitis, and one possible garlic-induced gastroenteritis.  In three cases, the inflammation was caused by direct injury, both by mechanical and possibly caustic effects.  Garlic was thought to have caused eosinophilic inflammation in the remaining two cases, both of which involved a significant atopic medical history.  Given the prevalence of garlic in both culinary and therapeutic settings, we believe clinicians should be aware of its potential for gastrointestinal symptoms.  Esophagitis and gastroenteritis should be on the differential as a cause of upper gastrointestinal symptoms in garlic users, especially in atopic patients.  In suspect patients, thorough medical histories, endoscopy, biopsies, and cutaneous testing may all be useful and should be utilized when appropriate.  Management should include avoidance of the offending agent, and supportive care.  Oral corticosteroids may be useful in certain patients. Follow-up endoscopy can be considered, especially in patients who have experienced direct injury.