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Drug-induced esophagitis
Other Resources UpToDate PubMed

Drug-induced esophagitis

Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


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


K20.80 – Other esophagitis without bleeding

47753002 – Esophagitis medicamentosa

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Gastroesophageal reflux disease not related to oral medication
  • Esophageal carcinoma
  • Esophageal foreign body
  • Scleroderma
  • Esophageal motility disorder
  • Atypical angina (see Acute coronary syndrome, Coronary artery disease)
  • Eosinophilic esophagitis
  • Esophageal web or Esophageal stricture
  • Esophagitis: reflux, infectious, radiation
  • Crohn disease or Behçet syndrome with upper gastrointestinal tract involvement

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:01/23/2018
Last Updated:09/16/2020
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Drug-induced esophagitis
A medical illustration showing key findings of Drug-induced esophagitis : Dysphagia, Dyspepsia, Retrosternal chest pain
Copyright © 2024 VisualDx®. All rights reserved.