Esophagitis, Pill-Induced

Key Features

• 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

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Potassium chloride tablets

  • Quinidine

  • Risedronate

  • Tetracycline

  • Trimethoprim-sulfamethoxazole

  • Vitamin C

  • Zalcitabine

  • 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

• Severe retrosternal chest pain

• Odynophagia

• Dysphagia

Diagnosis

• Endoscopy reveals one or several discrete, shallow or deep ulcers

• Severe esophagitis with stricture, hemorrhage, or perforation

Treatment

• 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