Pill Esophagitis Explained: Symptoms, Causes, Treatment

Pill esophagitis, or drug-induced esophagitis, occurs when oral medications cause inflammation in the esophagus, the tube that carries food from the throat to the stomach.

Symptoms can range from mild to severe and include chest pain, heartburn, and painful swallowing. In severe cases, people may develop ulcers or bleeding if a pill damages the esophageal lining. 

Pill esophagitis is rare, but anyone who takes medications, vitamins, or dietary supplements in pill or capsule form can develop it. Treatment generally involves stopping the medication causing the esophagitis.

Symptoms of pill esophagitis can develop within hours or up to 10 days after taking medication. In most cases, symptoms typically worsen before gradually improving within a few days. Common pill esophagitis symptoms include: 

• Odynophagia (throat pain when swallowing)
• Chest pain that may feel like a burning, gnawing pain similar to heartburn 
• Dysphagia (difficulty swallowing food, liquids, or saliva)
• Feeling as if something is “stuck” in your throat 

Some people with pill esophagitis can experience more severe inflammation that damages the esophageal tissues, leading to ulcers (open sores) that can bleed and symptoms such as: 

Pill esophagitis occurs when certain medications irritate or injure the esophagus’s lining. Some drugs have acidic or highly concentrated properties that can burn or injure the esophagus if they stay in contact with it for too long.

Taking pills without enough water or lying down shortly after taking medication can cause pills to stick to the esophageal lining, causing irritation and inflammation.

Gel capsules and slow-release pills are more likely to cause pill esophagitis because they can stick to the esophagus and slowly release irritating substances. Some medicines are more likely to cause pill esophagitis than others, including:

• Antibiotics like doxycycline, tetracycline, and clindamycin 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Clanza CR (aceclofenac), and Advil (ibuprofen) 
• Bisphosphonates (osteoporosis medicines), such as Boniva (ibandronate) and Fosamax (alendronate)
• Tylenol (acetaminophen)
• Warfarin (blood thinner), under brand names Jantoven and Coumadin
• Iron supplements
• Vitamin C (ascorbic acid) supplements 
• Potassium chloride supplements

Risk Factors

People of all ages, including children and adults, can develop pill esophagitis. There is a greater risk of pill esophagitis for people who: 

• Drink less than 3.3 ounces (100 milliliters) of water when taking pills or swallowing them without water 
• Take capsules that can stick to the walls of the esophagus 
• Take medications immediately before lying down for bedtime 
• Take large-sized pills or supplements 
• Have low saliva production (dry mouth); this is common in older adults and people with conditions that cause dry mouth, such as Sjogren’s syndrome. 
• Have a motility disorder (e.g., achalasia) or esophageal strictures (narrowing of the esophagus) that cause difficulty swallowing and increase the time pills spend in the throat 

Diagnosing pill esophagitis involves a thorough medical history review, physical examination, and diagnostic tests. Your healthcare provider will ask about your symptoms and what medications and supplements you’ve taken recently. They will also examine your throat, chest, and abdomen.

Healthcare providers can sometimes diagnose pill esophagitis based on your symptoms and recent medication history. For example, if you’re experiencing painful swallowing and chest pain while taking an antibiotic, this may be enough for your healthcare provider to make a diagnosis. 

Depending on the severity of your symptoms, your healthcare provider may order an endoscopy. An endoscopy involves inserting a flexible tube with a tiny camera into your mouth and throat. This allows healthcare providers to view the esophagus and look for signs of inflammation and abnormalities, like ulcers, strictures (narrowing of the esophagus), and bleeding.

Treatment for pill esophagitis depends on the severity of symptoms and damage to the esophagus. In many cases, simply stopping or replacing the medication causing the problem is enough to allow the esophagus to heal. Your healthcare provider may suggest an alternative medication or a liquid form of the same drug to reduce irritation.

Medications

Over-the-counter (OTC) and prescription medications can help relieve pain and discomfort and promote healing of the esophagus. Your healthcare provider may recommend or prescribe: 

• Antacids: OTC antacids, such as Milk of Magnesia (magnesium hydroxide) and Tums (calcium carbonate), neutralize the effects of stomach acids to provide quick, short-term pain relief. 
• Proton pump inhibitors: OTC drugs such as Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole) suppress stomach acid production and help reduce acidity in the esophagus.
• H2 receptor blockers: OTC medicines like Pepcid (famotidine), Axid (nizatidine), and Tagamet (cimetidine) reduce stomach acid production to prevent worsening esophageal irritation and promote healing.
• Sucralfate: Carafate (sucralfate) is a liquid prescription drug that coats the esophagus, acting as a protective barrier to reduce pain and discomfort. 

Dietary Changes

In addition to medications, your healthcare provider may recommend avoiding foods and beverages that can irritate the esophagus and worsen symptoms, including: 

• Alcohol 
• Acidic foods, including citrus fruits and juices and tomatoes 
• Spicy foods, including peppers, chilis, and curries 
• Hard foods, such as crackers, nuts, and raw vegetables 
• Chocolate 
• Peppermint 
• High-fat or fried foods 

Medical Procedures

Damage to the esophagus may require medical procedures or surgery to stop the bleeding or dilate (widen) the esophagus. These include:

• Endoscopic hemostasis: If ulcers in the esophagus are bleeding, an endoscopic procedure can help stop the bleeding. This procedure involves passing a flexible tube with a camera and surgical tools down the esophagus. This allows healthcare providers to locate and treat the bleeding areas using techniques like thermal coagulation (heat) or injection therapy (medicine).
• Esophageal dilation: Strictures, or narrowing of the esophagus, can make swallowing difficult. In this procedure, your healthcare provider will use a small balloon or similar dilator to stretch and widen the esophagus, making swallowing easier. 

Preventing pill esophagitis involves making a few simple adjustments when taking medications, including: 

• Always swallow pills with a full glass of water to help them pass through the esophagus smoothly
• Stand or sit up straight when swallowing pills 
• Drink more water or eat food if you swallow a pill but can still feel it in your throat
• Avoid lying down for at least 30 minutes after taking oral medications 
• Ask your healthcare provider if a liquid or chewable form of your medication is available if you have difficulty swallowing pills

Pill esophagitis can sometimes lead to complications, such as:

• Esophageal ulcers: Open sores in the esophagus can form due to ongoing irritation and inflammation. Esophageal ulcers can bleed, requiring more in-depth treatment to stop the bleeding and prevent extensive blood loss.
• Esophageal strictures: Inflammation can cause the esophagus to narrow, making swallowing difficult.
• Esophageal perforation: Although rare, severe cases can lead to perforation (a tear in the esophagus), which can cause severe and life-threatening infections.

Pill esophagitis is inflammation and irritation of the esophagus that occurs when a pill gets stuck or dissolves in the esophagus. It often happens when people swallow pills with too little water or lie down shortly after taking medication. 

Symptoms include chest pain and painful swallowing. Depending on the severity of symptoms, treatment may include stopping the medication causing esophagitis, medications to relieve symptoms, and dietary changes to prevent further irritation.

You can lower your risk of pill esophagitis by swallowing pills with a full glass of water and avoiding lying down for at least 30 minutes afterward.