What is Pill Esophagitis?

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.