Pill Esophagitis and Medication-Induced Throat Pain

Pill esophagitis, also known as drug-induced esophagitis, is pain and discomfort felt inside the chest and throat after swallowing certain medications. The pain occurs inside the tube, called the esophagus, that connects the mouth to the stomach.

Pill esophagitis (esophag- referring to the esophagus and -itis referring to inflammation) is caused by the irritating effects of certain medications, including antibiotics and anti-inflammatory drugs. Symptoms such as chest pain and heartburn can range from mild to severe and last for a short time or persist for days. Adults and children can both be affected.

This article describes the symptoms and causes of pill esophagitis as well as how the condition is diagnosed and treated. It also offers tips on how to avoid esophagitis if you frequently experience pain after swallowing pills, tablets, or capsules.

Causes 

Pill esophagitis is about more than a pill "getting stuck in the throat." It is caused when certain medications injure the lining of the esophagus, called the esophageal mucosa, causing chest pain, heartburn, and other symptoms.

In the past, esophagitis was considered synonymous with acid reflux, the backflow of stomach acid into the esophagus. But, with pill esophagitis, the symptoms are induced not by stomach acid but by medications that alter the environment of the esophagus, making it either too acidic or too alkaline.

Medications Linked to Esophagitis

Certain medications are more likely to cause pill esophagitis than others. Among those most commonly linked to pill esophagitis are:

• Antibiotics, including doxycycline, amoxicillin, ciprofloxacin, metronidazole, and rifaximin
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin
• High blood pressure medications, including Altace (ramipril) and Norvasc (amlodipine)
  
• Bisphosphonates, such as Boniva (ibandronate) and Fosamax (alendronate)
• Tylenol (acetaminophen)
• Ascorbic acid (vitamin C)
• Coumadin (warfarin)
  

Risk Factors for Pill Esophagitis

Many other drugs have the potential to cause esophagitis if they remain in the esophagus longer than they should. The likelihood of this occurring may be increased by how a person takes a drug. Certain medical conditions can also impede the movement of drugs through the esophagus.

Risk factors for pill esophagitis include:

• Not drinking enough water when taking pills or swallowing them "dry"
• Taking gelcaps that can "stick" to the wall of the esophagus
• Taking capsules that can break open prematurely and get stuck in the folds of the esophagus
• Taking sustained-release drugs that break down slowly
  
• Taking pills before sleeping, which allows pills to rest in the esophagus
• Having low saliva production, common in older people
• Having motility disorders such as achalasia that cause difficulty swallowing
• Having abnormalities such as esophageal strictures (narrowing of the esophagus), which can "trap" pills

Symptoms

The symptoms of pill esophagitis are the result of damage caused to the lining of the esophagus. Symptoms can occur soon after swallowing a pill but may occur days later, particularly with sustained-release drugs. The symptoms can also get progressively worse if "kissing ulcers" develop.

Classic signs and symptoms of pill esophagitis include:

• Feeling like a pill is stuck in your throat
• Mid-chest pain (sometimes mistaken for heartburn)
• Throat pain when swallowing (known as odynophagia)
• Difficulty swallowing (known as dysphagia)
  
• Dull shoulder pain
  

Complications

Many cases of pill esophagitis resolve on their own without any long-term consequences. But, people with chronic or recurrent esophagitis can experience a serious injury, leading to complications such as:

• Esophageal strictures: The formation of scar tissues can cause the esophageal wall to "pinch" and become narrower. Esophageal strictures are both a cause and effect of pill esophagitis.
• Esophageal perforation: Long-term damage to the esophageal wall can cause the lining to thin and become vulnerable to perforations (tears). Severe ulcers can do the same.
• Hematemesis: Vomiting or coughing blood is a rare complication of pill esophagitis. There may also be dark, sticky stools (referred to as melena).

Diagnosis

The diagnosis of pill esophagitis can be made by your primary care provider but often involves a specialist known as a gastroenterologist who is trained in disorders of the digestive tract.

The diagnosis would start with a review of your symptoms and medical history, including the types of drugs you take. A physical examination of your throat and chest sounds is also involved.

In some cases, all that is needed to make a diagnosis are symptoms of mid-chest pain, dysphagia, or odynophagia paired with the recent use of medications known to cause esophagitis.

In severe cases (or cases where symptoms persist despite stopping the offending drug), the healthcare provider may order a procedure called an upper endoscopy. This involves the insertion of a flexible, lighted scope into your mouth and throat to view the inside of the esophagus. Upper endoscopy is typically done under mild sedation to induce "twilight sleep."

Treatments

If you have pill esophagitis, the first thing your healthcare provider may recommend is stopping the offending drug. This may require a drug substitution or a change in your treatment plan.

If needed, your healthcare provider may prescribe the following medications to relieve symptoms and aid with healing:

• Proton pump inhibitors (PPIs): These are over-the-counter (OTC) and prescription drugs like Prilosec (omeprazole) or Protonix (pantoprazole) that suppress the production of stomach acid and reduce esophageal acidity.
• Antacids: These are OTC drugs like Tums (calcium carbonate) or Milk of Magnesia (magnesium hydroxide) that help block the effects of acid in the stomach and esophagus.
• Carafate (sucralfate): This is a prescription medication taken in liquid form that coats the lining of the esophagus to block acid and help ulcers heal.
• Oral lidocaine spray: This is an OTC numbing spray used to treat sore throat.

You would also be advised to avoid hot, spicy, or acidic food until ulcers are fully healed.

Prevention

Changing medications may only be part of the solution if you have pill esophagitis. There are certain habits you can adjust to help reduce the risk of future episodes.

If you are prone to pill esophagitis, the following practical tips may help:

• Stand or sit upright whenever swallowing pills. 
• Drink a sip or two of water before taking a pill.
• Drink an entire glass of water after taking a pill.
• Take your pills one at a time rather than all at once.
• Eat some food after taking a pill.
  
• Wait 30 minutes or longer after taking a pill before lying down.
  

Summary

Pill esophagitis is an injury to the esophagus caused by certain drugs like antibiotics. Symptoms include mid-chest pain, difficulty swallowing, or pain with swallowing.

The diagnosis of pill esophagitis typically involves a physical exam, a review of your symptoms and medical history, and possibly an examination of the esophagus with a procedure known as an upper endoscopy.

Pill esophagitis is typically treated by stopping or replacing the offending drug. Antacids like Tums and proton pump inhibitors like Prilosec may be prescribed to relieve symptoms and aid with healing.

A Word From Verywell

If you experience pill esophagitis frequently or severely, it is important to see a healthcare provider. In some cases, you may have an undiagnosed condition like achalasia or an esophageal stricture that requires specialist treatment.

Leaving conditions like these untreated can diminish your quality of life and lead to complications like megaesophagus (in which part of the esophagus widens and loses its ability to move food into the stomach).