Search
medication-induced esophagitis; pill esophagitis
Etiology:
1) medications directly injuring esophageal mucosa:
a) tetracycline
b) doxycycline
c) quinidine
d) potassium supplements
e) ferrous sulfate
f) ascorbic acid
g) NSAIDs
h) bisphosphonates
2) medications diminishing lower esophageal sphincter pressure:
a) nitrates
b) calcium channel blockers
c) benzodiazepines
d) anticholinergics
e) antidepressants
f) opioids
3) risk factors
- GERD
- decreased salivary output
- large pills
- ingestion of medications in the supine position
- taking pills without adequate water ingestion.
Epidemiology: more common in the elderly
Pathology:
1) mid-esophageal inflammation, with sparing of distal esophagus
2) associated with:
a) abnormal motility
b) stricture
c) compression (left atrial enlargement)
3) acidic environment
4) decreased esophageal motility prolongs the pill contact time
Clinical manifestations:
- symptoms may occur several hours after taking medication
- odynophagia
- dysphagia
- heartburn
Special laboratory:
- upper gastrointestinal endoscopy if conservative measures fail (see management)
Management:
- stop offending medication if possible
- drink plenty of water with medication
- avoid lying down for 30 minutes after ingestion [3]
General
esophagitis
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 284-85
- Prescriber's Letter 14(12): 2007
Drug-induced esophageal irrigation
Detail-Document#: 231203
(subscription needed) http://www.prescribersletter.com
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022
- Syed M.
Pill-induced oesophagitis.
Postgrad Med J. 2021;97:349-350.
PMID: 32423921