Esophagitis, Pill-Induced

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

Severe retrosternal chest pain

Odynophagia

Dysphagia

Endoscopy reveals one or several discrete, shallow or deep ulcers

Severe esophagitis with stricture, hemorrhage, or perforation

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