Drug-induced esophagitis can occur when a swallowed pill fails to fully traverse the esophagus and dissolves in the esophagus ("pill esophagitis"). It can also occur in the absence of any pill becoming lodged; drugs that have a very low pH when dissolved in saliva can cause acute gastroesophageal reflux disease (GERD), leading to esophagitis.

Pill-mediated disease often occurs at anatomical sites of narrowing including the aortic arch, left mainstem bronchus, and distal esophagus in patients with left atrial enlargement or in the setting of motility disorders or esophageal strictures. Patients often present with retrosternal chest pain, heartburn, odynophagia, and dysphagia within hours or days of ingesting the causal medication, although symptoms can present up to one month following ingestion.

Drug-induced esophagitis occurs more frequently in patients who take pills prior to lying flat or with inadequate water intake, or in patients taking a large-sized pill. Commonly implicated medications include tetracycline, doxycycline, clindamycin, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, potassium chloride, quinidine preparations, iron compounds, emepronium, alprenolol, and pinaverium.

Related Topics: Drug-induced dysphagia, Drug-induced hematemesis