What is Pill Esophagitis?

woman holding her throat in pain

The Bottom Line

Pill esophagitis occurs when capsules or tablets get stuck in the esophagus (food pipe) and cause tissue damage. Antibiotics, including doxycycline, and gelatin capsules are common causes of pill esophagitis. This condition is often painful, but typically resolves after discontinuation of the responsible medication.

man holding medication in one hand and a glass of water in the other

Why are pills hard to swallow?

A substantial number of Americans take several pills each day, and approximately half of them report having difficulties swallowing them. One reason for that is because pills are designed to transport active drug ingredients into the body, and are not specifically manufactured for ease of swallowing. The size, shape, and texture of pills can contribute to swallowing difficulties for patients. Hard and soft gelatin capsules, oval pills, and oblong-shaped tablets are more likely to cause swallowing difficulties than round pills or irregular-shaped tablets.

What causes pill esophagitis?

While the esophagus is often thought of as a rigid tube that helps food pass from the mouth into the stomach, it is actually a muscular structure that stretches to accommodate food, fluids, and medications. Sometimes, the esophagus is unable to stretch enough to allow pills to pass through. When this happens, pills can get stuck in the esophagus and cause tissue damage. Pill esophagitis is a condition caused by medications that lodge in the esophagus, dissolve there, and cause ulcers, inflammation, and damage to the esophageal tissue.

Who is at risk for pill esophagitis?

Women are more likely than men to develop pill esophagitis, and the condition can affect individuals of any age. Older individuals and individuals who use antihistamine medications (including Benadryl®), may have decreased saliva production or dry mouth. The lack of saliva can also slow the passage of pills through the esophagus and increase the risk for pill esophagitis. 

What medications cause pill esophagitis?

Tetracycline antibiotics (including doxycycline), large-sized pills, and gelatin capsules are common causes of pill esophagitis. Doxycycline, iron supplements, and vitamin C pills release acidic solutions when dissolved in water or saliva. The antiseizure medication phenytoin (Dilantin®) produces alkaline fluid when mixed with water. The acidic or alkaline fluid can cause tissue damage and burns when these pills become stuck in the esophagus. Sustained-release formulations are more likely to cause pill esophagitis than immediate-release formulations, since the slow release of pill contents allows for continued damage to the esophageal tissue. The type of pill can also contribute to the development of pill esophagitis, and capsules are three times as likely as tablets to get stuck in the esophagus.

What are symptoms of pill esophagitis?

Painful swallowing, which often occurs suddenly and without warning, is a common symptom of pill esophagitis. Affected individuals may also experience chest pain, back pain, and discomfort or difficulty in swallowing solids or liquids. Gastrointestinal bleeding, manifested as bloody stools or vomit, may indicate a more serious condition such as a pill penetrating through a blood vessel. 

What is the treatment for pill-induced esophagitis?

The main treatment for pill esophagitis is to stop use of pills that cause the condition. In some cases, pain relievers, H2 blockers (such as famotidine), or other antiulcer medications may be prescribed to treat pill esophagitis. Avoidance of acidic or irritating foods (such as citrus fruits and alcohol) may help alleviate the signs and symptoms of esophageal ulcerations related to pill use.

How long does pill induced esophagitis last?

Typically, pill esophagitis resolves within days to weeks, as long medications responsible for the condition are discontinued. Some individuals with severe pill esophagitis may require surgical treatment of ulcers, bleeding, or scar tissue.

How do you prevent pill esophagitis?

To prevent pill esophagitis, individuals should take all medications while in an upright position. Pills should be swallowed with 4-8 ounces of water, and patients should remain upright for 10-30 minutes after taking medications. Individuals with underlying esophageal disease, such as diverticulosis or dysmotility disorders, should consider the use of liquid medication formulations or crushed pills instead of standard tablets and capsules.

What happens if someone develops pain after taking a pill?

For questions about adverse or unexpected symptoms after taking medications, contact Poison Control for expert advice. There are two ways to contact Poison Control in the United States: online at www.poison.org or by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.

Kelly Johnson-Arbor, MD
Medical Toxicologist

For media inquiries, please contact Krista Osterthaler at osterthaler@poison.org.

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • Talk to your doctor if you have difficulty swallowing medications.
  • Take all solid medications, including tablets and capsules, with at least 4 ounces of water.
  • Avoid sleeping or laying down for at least 10 minutes after taking medication.

This Really Happened

A 28-year-old woman was referred to a gastroenterology clinic due to severe chest and back pain and painful, difficult swallowing. Her only medical history was acne, for which she was prescribed doxycycline. She had taken the doxycycline twice daily, with a small amount of water, right before going to bed for one week prior to development of her current symptoms. When the gastroenterology doctors inserted a small camera into her esophagus to evaluate for tissue damage, they discovered multiple ulcerations and inflammation. She was diagnosed with pill esophagitis related to doxycycline use. She was advised to discontinue use of doxycycline, eat a liquid diet, and take medications to help heal the esophageal ulcers. She followed these recommendations, and her symptoms resolved completely within four days. One month later, a repeat gastrointestinal examination revealed full healing of the esophageal ulcerations.

For More Information

Esophagitis (Mayo Clinic)

Drug-Induced Esophagitis: What Pharmacists Need to Know (Pharmacy Times)


References

Fields J, Go JT, Schulze KS. Pill Properties that Cause Dysphagia and Treatment Failure. Curr Ther Res Clin Exp. 2015 Aug 20;77:79-82.

Henry JG, Shinner JJ, Martino JH, Cimino LE. Fatal esophageal and bronchial artery ulceration caused by solid potassium chloride. Pediatr Cardiol. 1983 Jul-Sep;4(3):251-2.

Kikendall JW. Pill esophagitis. J Clin Gastroenterol. 1999 Jun;28(4):298-305.

Kilincalp S, Yuksel I. Severe Chest Pain, Odynophagia, and Dysphagia in a Young Woman. Gastroenterology. 2021 Oct;161(4):1116-1117. 

Panigrahi MK, Nayak HK, Samal SC. A recent surge of doxycycline-induced pill esophagitis during the corona virus disease 2019 (COVID-19) pandemic. Indian J Gastroenterol. 2022 Apr;41(2):206-207. 

Petersen KU, Jaspersen D. Medication-induced oesophageal disorders. Expert Opin Drug Saf. 2003 Sep;2(5):495-507. 

Schiele JT, Quinzler R, Klimm HD, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol. 2013 Apr;69(4):937-48. 

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • Talk to your doctor if you have difficulty swallowing medications.
  • Take all solid medications, including tablets and capsules, with at least 4 ounces of water.
  • Avoid sleeping or laying down for at least 10 minutes after taking medication.

This Really Happened

A 28-year-old woman was referred to a gastroenterology clinic due to severe chest and back pain and painful, difficult swallowing. Her only medical history was acne, for which she was prescribed doxycycline. She had taken the doxycycline twice daily, with a small amount of water, right before going to bed for one week prior to development of her current symptoms. When the gastroenterology doctors inserted a small camera into her esophagus to evaluate for tissue damage, they discovered multiple ulcerations and inflammation. She was diagnosed with pill esophagitis related to doxycycline use. She was advised to discontinue use of doxycycline, eat a liquid diet, and take medications to help heal the esophageal ulcers. She followed these recommendations, and her symptoms resolved completely within four days. One month later, a repeat gastrointestinal examination revealed full healing of the esophageal ulcerations.