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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
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Endoscopy reveals one or several discrete, shallow or deep ulcers
Severe esophagitis with stricture, hemorrhage, or perforation
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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