Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-17: Pill-Induced Esophagitis + Key Features Download Section PDF Listen +++ ++ Various medications may injure the esophagus through direct, prolonged mucosal contact or mechanisms that disrupt mucosal integrity Most commonly implicated: alendronate, clindamycin, doxycycline, emepronium bromide, iron, NSAIDs, potassium chloride tablets, quinidine, risedronate, tetracycline, trimethoprim-sulfamethoxazole, vitamin C, zalcitabine, and zidovudine Injury is most likely to occur if pills are swallowed without water or while supine Hospitalized or bed-bound patients are at greater risk + Clinical Findings Download Section PDF Listen +++ ++ Severe retrosternal chest pain Odynophagia Dysphagia + Diagnosis Download Section PDF Listen +++ ++ Endoscopy reveals one or several discrete, shallow or deep ulcers Severe esophagitis with stricture, hemorrhage, or perforation + Treatment Download Section PDF Listen +++ ++ Prevention by instructing patients to take pills with 4 oz water and to remain upright for 30 minutes after ingestion Known offending agents should not be given to patients with esophageal dysmotility, dysphagia, or strictures